应用改进逆行腓肠神经营养血管皮瓣修复下肢软组织缺损

Modified skin flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb for repair of lower extremity soft- tissues defects

目的探讨改进的逆行腓肠神经营养血管皮瓣修复下肢缺损的临床效果。方法2003年11月至2009年9月，临床应用改进逆行腓肠神经营养血管皮瓣修复下肢软组织损伤18例，男11例．女7例，年龄最大73岁，最小5岁，平均年龄45．9岁，修复部位为足背4例，足底3例，足跟2例，踝周2例，小腿下1／3处7例，其中骨外露创面8例，肌腱外露3例。手术修复软组织缺损面积大小为6cm×4cm～22cm×10cm，其中保留供区腓肠神经功能逆行腓肠神经营养血管皮瓣4例，带薄层肌肉的逆行腓肠神经营养血管皮瓣4例。结果改进应用后的18例皮瓣全部成活，经随访3个月～3年，下肢功能及外形恢复满意，保留神经的4例供区及神经支配区域经两点辨别觉检查显示感觉功能恢复良好，无不良反应及并发症发生。结论通过改进皮瓣手术方式，使皮瓣血运更为丰富，成活率高，并保留小腿皮瓣供区的感觉功能．减少对供区的损害，手术简便安全。

Objective To investigate the modified methods and effects of the flaps with nutrient vessels of superficial vein-cutaneous nerve of lower limb which used for repair of the lower extremity soft-tissues defects. Methods Between December 2003 and September 2009, 18 patients were treated with this modified skin flap, in which 11 cases mate; 7 cases were female, age from 5 to 73 years. Average age was 45.9 years. Repair parts： 4 cases of dorsal foot, 3 cases of foot, heel in 2 cases, the ankle weeks in 2 cases, calves under 1 / 3 of 7 cases, of which 8 cases of bone exposure wounds, tendons exposed in 3 cases. Surgical repair of soft tissue defect size of about 6 cm× 4 cm-22 cm × 10 cm, which retained the donor sural nerve function retrograde sural nerve flap in 4 cases, with a thin layer of muscle retrograde sural nerve flap in 4 cases. Results All the flaps were survived completely without any complications. The appearance and functional results were satisfactory with following up for 3 to 36 months. 18 cases of flap were survived completely, primary healing, without any complications such as vein congestion or engorgement. The 4 cases which remains the cutaneous nerve in site had an average recovery time about 13 days of the donor site. The innervated region of the cutaneous nerve had no acroesthesia or dysesthesia. Conclusion This modified operation methods of flap, enhanced the blood support of the flap, improved the survive rates and also preserved the sensory function of the patients＇ donor site. This modified flap with nutrient vessels of superficial vein-cutaneous nerve is a convenient and safe method in repairing lower extremity soft-tissues defects.