腓肠神经营养血管皮瓣逆行修复足跟及踝部软组织缺损的临床观察

Repairing softtissue defection of ankle and foot by sural neurovascular pedicle fasciocutaneous reversed flap

目的比较应用逆行腓肠神经营养血管皮瓣及交腿皮瓣修复足踝部软组织缺损的愈后以及患者的满意度。方法选取66例因车祸外伤而致足跟及踝部软组织缺损患者及2例足跟部黑色素瘤患者,随机分为A组32例和B组36例。A组应用交腿皮瓣,B组应用逆行腓肠神经营养血管皮瓣修复创面。结果 A组32例,术后感染2例,皮瓣撕脱2例。B组36例,术后皮瓣血运良好,36例成活,2例皮瓣边缘部份浅表坏死,经换药延迟愈合,随诊6个月～1年,皮瓣质地、肤色良好,外观及功能满意。患者满意度B组高于A组(P<0.01)。结论与交腿皮瓣相比逆行腓肠神经营养血管皮瓣是修复足跟及踝部软组织缺损的理想方法。

Objective To compare with the patients＇ satisfactions and complications about the prognosis of retrograde sural neurovascular flap and cross-leg flap for repairing soft tissue defect of foot and ankle.Methods 66 patients with soft tissue defect of heel and ankle caused by car accident and 2 patients with melanoma were randomly divided into Group A of 32 patients and Group B of 36 patients.Group A deals with the methods of cross-leg flap,while Group B deals with retrograde sural neurovascular flap to repair the wound.Results Among 32 patients in Group A,2 cases suffered from postoperative infections,2 cases suffered from avulsion flap.36 patients in Group B had good blood circulation flap,36 patients survived,and 2 cases of superficial part of flap edge necrosis,delayed healing after dressing change.Followed up for 6 months to 1 year,flap texture,color,sound,appearance and function were satisfactory.Patients＇ satisfaction in Group A is better than those in Group B（P0.01）.Conclusion Compared with the cross-leg flap,retrograde sural neurovascular flap is the ideal method to repair soft tissue defects of foot and ankle.