腓肠神经营养血管皮瓣修复足踝部软组织缺损的疗效分析

The clinical effect of sural neurovascular flap to repair soft tissue defects in ankle-heel region

目的应用腓肠神经营养血管皮瓣修复足踝部软组织缺损,探讨不同的小隐静脉处理方法对皮瓣成活率的影响。方法应用腓肠神经营养血管皮瓣修复足踝部软组织缺损29例29足;切取皮瓣面积:7 cm×6cm～12 cm×8 cm;皮瓣血管蒂长8～17 cm,蒂宽3～4 cm。结果皮瓣移位后小隐静脉不处理组2例、远端结扎组2例发生了静脉危象,经保守治疗后,各有1例出现约1/4皮瓣坏死;而静脉剥离组和静脉吻合组均无静脉危象和皮瓣坏死现象发生。皮瓣全部成活。29例均获随访,时间4个月～3年,皮瓣色泽、弹性均正常,无臃肿,外观良好,踝关节功能基本正常。大部分恢复了保护性感觉,两点辩别觉为12～16 mm。结论腓肠神经营养血管皮瓣血运良好,手术操作简便、安全,可有效修复足踝部皮肤软组织缺损。

Objective To explore the clinical effect of sural neurovascular flap to repair soft tissue defects in ankle-heel region,and to explore the impact on the flap survival rate through different treatments of small saphenous vein.Methods 29 cases of soft tissue defects in ankle-heel region were repaired with sural neurovascular flaps.The flaps were harvested from 7 cm×6 cm^12 cm×8 cm with pedicles 8~17 cm in length and 3~4 cm in width.Results After flap shifting,2 cases venous crisis occurred in each group with no treatment of small saphenous vein and group with distal ligation,after conservative treatment,there was one quarter necrosis in 1 case in each group;There was no venous crisis and skin flap necrosis in group with vein stripping and group with venous anastomosis.All flaps survived.29 cases were all followed up for 4 months^3 years.The color,elasticity and out-looking of flaps were satisfactory,and the function of ankle joints turned normal or almost normal.There was no overstuffing of flap.The protective sensation was recovered mostly with two-point discrimination of 12~16 mm.Conclusions Distally-based sural neurovascular flap has sufficient blood supply.The operation is simple and safe and it can repair effectively the soft tissue defects of the ankle-heel region.