隐神经-大隐静脉营养血管与胫后动脉皮支蒂联合皮瓣修复足部慢性溃疡创面

Application of combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repair of chronic ulcer in foot

目的探讨应用隐神经-大隐静脉营养血管与胫后动脉皮支蒂联合皮瓣修复足部慢性溃疡的疗效。方法应用隐神经-大隐静脉营养血管与胫后动脉皮支为蒂的联合皮瓣修复足部慢性溃疡共18例，6例手术前创面先行负压封闭引流技术治疗，待创面新鲜肉芽组织生成后再行联合皮瓣移植修复。足部术中清创后创面面积为8cm×13cm至1cm×17cm，设计的皮瓣面积为8cm×14cm至11cm×18cm。结果18例中，经疗效判断标准评定，优10例，良8例。其中17例创面Ⅰ期愈合，1例因静脉回流障碍皮瓣远端小面积坏死，经皮片移植后愈合。术后随访6～24个月，均取得满意效果。结论隐神经-大隐静脉营养血管与胫后动脉皮支蒂联合皮瓣对修复足部慢性溃疡，特别是足跟部创面具有显著的疗效。

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combined saphenous nerve- great Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distally- pedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot.