腓肠神经滋养血管皮瓣逆行转移修复小腿或足部皮肤缺损

The Sural Neurocutaneous Vascular Flap Reconstruction for the Soft-tissue Defect Caused by Radical Resection of Wounds in Leg and Foot

目的:介绍小腿或足部皮肤缺损,以腓肠神经滋养血管皮瓣逆行转移修复的临床效果。方法:受区彻底清创,清除失去活力的组织,再依软组织缺损面积切取腓肠神经营养血管皮瓣,共修复软组织缺损22例。切取皮瓣面积最大25 cm×10cm,最小8 cm×6 cm,逆行转移时全部开放隧道以保证蒂部的宽松,同时确保皮瓣的筋膜蒂宽度在5 cm以上。结果:应用该方法共处理22例,术后皮瓣21例全部成活,1例皮瓣远端部分坏死,经换药后肉芽生长良好,2期植皮愈合。随访6个月～2年,皮瓣质地良好,功能良好、外形满意。结论:逆行腓肠神经滋养血管皮瓣解剖位置恒定、血供可靠、可切取面积大、耐磨且操作简单,是修复小腿中下段胫前区及足踝部软组织缺损的理想皮瓣。

Objective：To provide a restoring way of soft-tissue defect caused by radical resection of wounds in leg and foot and value the clinical effect of sural neurocutaneous vascular flap. Methods： To dissect the sural neurocutaneous vasculariz ed flap for reconstruction, depending on the size of soft-tis sue defect of recipient wound after debridement of recipient wound and removal of devitalized tissue. Using the sural neurocutaneous vascularized flap to restore the soft tissue defect in leg and foot totalized 22 cases, flap square from 25 cm × 10 cm to 8 cm × 6 cm. To make sure the pedicle loose and increase the flap width of its fascia1 pedicle （the width was above 5cm） when reversely transplanting. Results： Using this method, we treated 22 patients. Among them, the distal epidermises of one flap were partially necrosized and healed after changing dressings and skin graft while the rest were uneventful postoperatively. All cases were followed up for 6 months - 2 years, the quality of the flaps were good and the appearance of the flaps were satisfactory. Conclusion： The retrograde sural neurocutaneous vascularized flap is a better choice for reconstruction of the soft-tissue defect caused by radical resection of wounds in leg and foot because of its constant vascular pedicle, reliable blood supply, easily harvesting and wear-resisting.