足踝部大面积皮肤软组织缺损的修复

Reconstruction of the large soft tissue defects of the ankles and feet

目的 探讨足踝部大面积皮肤软组织缺损的修复方法.方法 采用逆行排肠神经营养血管筋膜皮瓣、小腿内侧逆行岛状皮瓣及游离背阔肌皮瓣修复足踝部大面积皮肤软组织缺损28例.结果 术后28例中2例出现皮瓣远端坏死,2例皮瓣边缘部分坏死,经换药、抗感染和植皮后创面愈合,其余均成活,创面一期修复,骨、肌腱、钢板得以覆盖,成功率为92.9%.术后2年随访12例,根据Swanson等制定的周围神经损伤临床疗效评定方法评定,感觉恢复至S43例,S3 7例,S2 2例;足踝功能恢复较好,可负重,无慢性溃疡发生,排肠神经营养血管筋膜皮瓣及小腿内侧岛状皮瓣外形均比较满意,背阔肌皮瓣外形较为臃肿,分两次行修薄术后,外形基本满意.结论 根据缺损的部位及大小选用上述三种皮瓣来修复足踝部大面积皮肤软组织缺损,可获得良好的临床效果.

Objective To study reconstruction of the large soft tissue defects of the ankles and feet. Methods Retrograde sural nerve anadesma flap, Calf retrograde island flap and free latissimus dorsi muscle flap to repair large areas of foot and ankle soft tissue defects in 28 cases. Results It happened distal necrosis in 2cases, edge necrosis in 2 cases.And survived after dressing, anti-infective and skin grafting, Bone, tendon, steel plate were covered, the success rate was 92.9%（26/28）. The follow-up period ranged 2 years in 12 cases, according to Swanson evaluated standard for sural nerve, sensory recovered $4 in 3 cases,S3 in 7 cases,S2 in 2 cases. The function of ankle and foot had a good restoration, and could bear a heavy burden, had no-chronic ulcer. Conclusion It can obfain good clinical effect, that selecting these three flaps to repair the defect of ankle and foot, according to the location and size.