小腿及足踝部组织缺损的修复与重建

目的探讨小腿及足踝部组织缺损的修复与重建的优化选择。方法分析423例病例，应用10余种邻近非主干血管蒂（肌）皮瓣转移和游离皮瓣修复小腿及足踝部皮肤缺损。小腿及足踝部软组织缺损周围皮肤条件良好者，选择邻近的非主干血管蒂（肌）皮瓣转移；皮肤缺损范围大者，组合逆行腓肠神经营养血管皮瓣与肌瓣或游离皮瓣。结果所有病例随访6—12个月，成活412例，9例远端少部分坏死，其中4例局部皮瓣转移修复，1例肌瓣转移，4例肉芽组织生长后植皮修复；2例游离皮瓣术后血管危象坏死，Ⅱ期游离皮瓣修复。伤口Ⅰ期愈合397例，21例经伤口换药后Ⅱ期愈合，其中5例术后感染加重，予以伤口清创、置管持续冲洗后伤口愈合。结论小腿及足踝部损伤多种类型，不同的术式可满足各种创面的要求。手术的选择是关键。

Objective To explore the calf and ankle with reconstruction of defect repair optimal choice. Methods To analyze 423 cases, application of adjacent the trunk muscle） pedicle flap transfer （ free flap to repair crus and ankle and skin defect. Leg and ankle department tissue defect surrounding skin condition, the choice of the adjacent fluent backbone vascular pedicle flap transfer （muscle）, Great scope, combination skin defect retrograde sural nerve and muscle flap nutrient vessels or free flap. Results All cases were followed up for 6 - i2 months, 9 cases survived 412 subjects, remote minority necrosis, 4 cases of local flap to repair, 1 case muscle flap transfer, 3 cases of granulation tissue repair skin after growth, Two cases of vascular surgery free flap necrosis, the second crisis free flap to repair. Wound healed, and 397 by bandage wound healing, including 5 after the second post - surgical infections aggravating, wound debridement, spacer rinse wound healing. Conclusion Crus and ankle injury, different types of surgical can meet various demands of the wound. The selection is a key operation.