远端蒂皮神经营养逆行皮瓣修复足踝部软组织缺损

Reconstruction of foot and ankle soft tissue defect with distal neurocutaneous vascular flap

目的:探讨应用多种神经营养血管逆行皮瓣治疗足踝部软组织缺损的临床效果。方法:应用以腓动脉、胫前动脉或胫后动脉穿支为远端蒂的神经营养血管逆行皮瓣修复足踝部缺损41例。皮瓣面积6 cm×5 cm^23 cm×16cm。结果:术后39例皮瓣Ⅰ期存活,1例出现皮瓣远端部分坏死,经换药植皮后痊愈;1例出现皮瓣下脂肪液化,经Ⅱ期清创再缝合后痊愈。随访1~12个月,1例足跟皮瓣由于负重出现缝合处瘢痕愈合,其余40例功能及外观恢复满意。结论:神经营养血管蒂岛状皮瓣具有血液供应可靠、操作简单、成活率高以及不牺牲重要血管等特点,是修复踝部、足跟部、足背及足内侧皮肤软组织缺损的理想方法之一。

Objective To explore the therapeutic effects of clinical applications of various distal neurocutaneous vascular flaps for reconstruction of soft tissue defect in foot and ankle.Methods Forty-one cases of soft tissue defects on foot and ankle were treated with different distal neurocutaneous vascular flaps,including sural neurocutaneous vascular flaps,peroneus superficialis neurocutanous vascular flaps and saphenus neurocutanous vascular flaps.The area of the flaps ranged from 6 cm×5 cm to 23 cm×16 cm.Results Thirty-nine flaps survived after operation.Partial necrosis occurred in the distal part of flap in one case.Lipid liquedaction occurred in one case and the flap survived after secondary debridement.All cases were followed up for 1 to 12 months.Except one case of scar healing indduced by weight-loading at the suture site,all the other 40 flaps exhibited satisfactory appearance and good functional recovery.Conclusion Distal neurocutaneous vascular flap,which is characterized by reliable blood supply,simple procedure and high survival rate,represents an ideal choice for the reconstruction of tissue defect in the ankle,heel,dorsum of the foot and medial of the foot.