带皮穿支血管的皮神经营养血管皮瓣在足踝部皮肤软组织缺损修复中的应用

Application of ankle skin soft tissue coloboma cutaneous repairing to treat branch blood vessel nerve of perforating nutrient vessel flap

目的：探讨带皮穿支血管与皮神经营养血管相结合的皮瓣手术方法及修复足部皮肤软组织缺损的临床应用效果。方法：2006年～2009年，我科对58例以远端蒂腓肠神经营养血管皮瓣修复小腿及足踝部不同原因所致皮肤软组织缺损病例进行总结分析。本组男58例，女7例；年龄6～57岁，平均35岁。其中外伤后踝部及足跟部皮肤软组织坏死10例，足背外伤后皮肤软组织缺损21例，胫腓骨下段开放性骨折手术后胫前皮肤坏死并骨与肌腱外露20例。小腿下段慢性溃疡皮肤缺损7例。缺损面积5cm×3cm～10cm×6cm。结果：58例患者中除2例皮瓣远端皮缘约1／4坏死，经换药后二期植皮外，余皮瓣均成活，伤口1期愈合。随访2个月～2年，皮瓣质地优良，色泽接近正常，局部稍饱满，修复缺损满意。结论：①远端蒂腓肠神经营养血管皮瓣转位修复小腿中下段及足踝部缺损创面，极有临床实用价值。②术前及术中判断小隐静脉是否存在不良作用，采取积极措施促进静脉回流对提高远端蒂腓肠神经营养血管皮瓣的成活率有重要意义。

Objective： Application of ankle skin soft tissue coloboma cutaneous repairing to treat branch blood vessel nerve of perforating nutrient vessel flap. Methods： 58 cases with ankle skin soft tissue coloboma cutaneous repairing to treat branch blood vessel nerve of perforating nutrient vessel flap.To divide these patients into diffrient group acording to their condition.Results： Two cases has been dermatoplastied two stage and others are all cured. Concl -usion： ①To repair distal end nervus suralis nutrient vessel flap middle and inferior segment leg and ankle has clinical practical value. ②To judge if there are adverse effect preoperative or in the operation and adopt energetic measure to promote venous return to improve survival rate of nervus suralis nutrient vessel flap.