吻合小隐静脉的腓肠神经营养血管皮瓣修复跟骨感染创面

Treating calcaneal infection wound with sural neuro-veno-fasciocutaneous flap of anastomosis small saphenous vein

目的报道应用吻合小隐静脉的腓肠神经营养血管皮瓣修复跟骨感染创面的临床效果。方法应用吻合小隐静脉的腓肠神经营养血管皮瓣修复跟骨感染软组织缺损创面11例，创面面积最大12cm×18cm，最小8cm×10cm，切取皮瓣面积最大14cm×20cm．最小8cm×10cm。在转移皮瓣时将小隐静脉与创面周围大隐静脉属支吻合。结果11例皮瓣术后均无明显肿胀、瘀血等现象。其中10例顺利成活，1例皮瓣因创面感染未控制致部分坏死，清创游离植皮后治愈。其中10例获4～36个月随访，平均18．4个月，按照美国足踝外科协会评分系统踝一后足评分系统（总分100分）进行评分，最高得分97分，最低84分，平均93．5分，皮瓣外形、色泽及足踝部功能满意。结论应用吻合小隐静脉的腓肠神经营养血管皮瓣修复跟骨感染所致的足跟部皮肤软组织缺损，操作简单，皮瓣成活率高，抗感染能力强，有利于骨感染创面的愈合临床效果好。

Objective To report the clinical effect of treating calcaneal infection wound with sural neuro- veno-fasciocutaneous flap of anastomosis small saphenous vein. Methods 11 cases with calcaneal infection were treated with sural neuro-veno-fasciocutaneous flap of anastomosis small saphenous vein. The maximal defect reached 18cm×12cm, and the minimal one was 8cm×10cm. The maximal flap was 20cm× 14cm and the minimal one was 10cm×8cm. When the flap was transferred, the small saphenous vein was anatomized with the branches of the great saphenous vein. Results There was no significant swelling and gore after the operation. The flaps in 10 cases survived, and the necrosis was observed after recurrent infection in 1 case, which was treated with debridement and free transplantation of skin. During the follow-up of average 18.4 months （6-36 months） in 10 cases, the highest score was 97, the lowest score was 84, and the average score was 93.5 according to the ankle-hind foot scoring system. The shape, color and function of ankle were satisfactory. Conclusion Treating skin and soft tissue defect after calcaneal infection with sural neuro-veno-fasciocutaneous flap of anastomosis small saphenous vein has advantages of easier procedure, higher resistance to infection, promotion the healing of the infectious wound and higher survival rate of flap, which lead to a better clinical outcome.