多种皮瓣修复小腿及足踝部皮肤软组织缺损

The Repair of Lower Leg, Ankle and Foot Soft Tissue Defects

目的评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果,探讨小腿及足踝部皮肤软组织缺损的理想修复方法。方法 2002年6月-2010年1月,应用15种皮瓣、肌皮瓣修复128例(138处)小腿及足踝部皮肤软组织缺损。其中小腿中上段21处,小腿中下段45处,内外踝及足跟部43处,足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。结果术后135处创面Ⅰ期愈合,皮瓣完全成活;2处皮瓣部分坏死,经二次手术植皮修复;1例游离股前外侧皮瓣修复小腿中下段软组织缺损,皮瓣完全坏死,后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多,成活率高,吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年,平均23个月,皮瓣均成活良好,无溃疡、渗液等。结论正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率,恢复肢体良好功能,腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。

Objective To evaluate the effect of different kinds of flaps and myocutaneous flaps in repairing lower leg, ankle and foot soft tissue defects, and research on the ideal repairing method. Methods From June 2002 to January 2010, 15 different kinds of flaps and myocutaneous flaps were used to repair 138 soft tissue defects in the lower leg, ankle and foot for 128 patients. The position of defects included superior segment of lower leg （n=21）, inferior segment of lower leg （n =45）, ankle and heel （n=43）, and dorsum of foot and fore-leg （n=29）. The mostly used flaps were sural neurocutaneous island flaps, medial or lateral gastrocnemis myocutaneous pedical flaps, superficial peroneal neurocutaneous flaps and medial plantar flaps. Results After operation, 135 flaps healed in stage I and the flaps completely survived.Two flaps with distal edge partially necrosis both healed after secondary operation of skin grafting. The remaining 1 flap with whole necrosis was finally cured after contralateral sural neurocutaneous flaps transplant. Superficial peroneal neurocutaneous flaps were mostly adopted due to its high survival rate, while microvascular free muscle flap had a high necrosis rate. The follow-up ranged from 1 to 10 years with an average of 23 months. All flaps survived well without ulcer or fluid leakage. Conclusions In order to elevate the survival rate of the flaps and recover better, it is important for us to make a correct evaluation and choice of the flaps to repair the soft tissue defects in the lower leg, ankle and foot. The sural neurocutaneous flap is a satisfactory material in repairing soft tissue defects in the lower leg, ankle and foot.