两种足内侧皮瓣修复前足皮肤缺损的疗效分析

Curative effect evaluation of two kinds of flap repairing forefoot skin defects

[目的]总结足内侧隐神经营养血管皮瓣(隐神经组)与?母趾底内侧动脉皮穿支血管蒂隐神经营养血管皮瓣(穿支蒂组)逆行修复前足皮肤缺损的疗效。[方法]2005年3月～2010年10月,采用隐神经组皮瓣和穿支蒂组皮瓣逆行修复前足皮肤缺损各16例、20例,对两组移植皮瓣术后淤血、坏死、愈合、负重后肿胀消退、感觉恢复等分析对比。[结果]隐神经组皮瓣淤血8例,表浅及以上坏死6例,Ⅱ期愈合6例;穿支蒂组皮瓣淤血2例,表浅坏死1例,Ⅱ期愈合1例。随访7月～19个月,平均12个月,负重后皮瓣均不同程度肿胀,隐神经组平均1.6个月消肿,穿支蒂组平均0.8个月消肿;感觉恢复:隐神经组S1 2例,S2 5例,S3 4例,S3+3例,S4 2例;穿支蒂组S2 1例,S3 3例,S3+7例,S4 9例。从皮瓣淤血、坏死、愈合、负重后消肿情况及感觉恢复等方面对比穿支蒂组优于隐神经组(P<0.05)。[结论]?母趾底内侧动脉皮穿支血管蒂隐神经营养血管皮瓣逆行修复前足皮肤缺损并发症少,功能恢复好,修复质量高,安全可靠。

[Objective]To sum up the clinical experience of repairing forefoot skin defects with medial pedal saphenous neurocutaneous vascular flap and medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap. [Method]Thirty-six patients were divided randomly into two groups：the group of medial pedal saphenous neurocutaneous vascular flap and the group of medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap,from March 2005 to October 2010.The congestion,necrosis,healing time,regression of flap swelling,recovery of sensation after operation were compared between the two groups. [Result]The group of medial pedal saphenous neurocutaneous vascular flap was found 8 patients of congested flap,6 patients of flap necrosis,6 patients of exceeding normal healing time.The group of medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap was found 2 patients of congested flap,1 patients of flap necrosis,1 patients of exceeding normal healing time.All patients were followed up for 7～19 months,with an average of 12 months.All flap swelled after operation.The regression of flap swelling time：tthe group of medial pedal saphenous neurocutaneous vascular flap with an average of 1.6 months,the group of medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap with an average of 0.8 months.All flaps survived with good sensibility.There were differences between the two groups.The group of medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap was better than the group of medial pedal saphenous neurocutaneous vascular flap（P0.05）. [Conclusion]Medial plantar artery perforator pedicle saphenous neurocutaneous vascular flap repair forefoot skin defects with less complications and good prognosis,are safe and reliable.