足跟部皮肤缺损一期修复的围手术期处理

SURGICAL INTERVENTION IN THE TREATMENT OF SKIN DEFECT OF HELL

目的 探讨足跟部皮肤缺损修复的围手术期处理。方法 本组 46例 ,采用 6种不同类型轴型皮瓣、肌皮瓣进行修复。其中足底内侧皮瓣 14例 ,趾短屈肌皮瓣 4例 ,口止母 展肌皮瓣 3例 ,背阔肌皮瓣 7例 ,小腿内侧远端胫后动脉皮肤穿支皮瓣 16例 ,足背皮瓣 2例。结果 手术全部成功 ,随访 3个月～ 4年 ,43例皮瓣有良好感觉功能 ,负重后无溃疡发生。3例感觉功能差 ,其中 1例负重后皮瓣肿胀 ,有水泡形成。结论 修复方法根据病情而定 ,带蒂皮瓣注意保护好神经 。

Objective\ To investigate the efficacy of different flaps in the treatment of skin defect of hell. Methods\ Forty six patients with skin defect of hell were adopted in this study. There were 39 males and 7 females, 29 years old in average. Six different flaps were applied in the reconstructive operation, 14 plantaris medialis flaps, 4 flexor digitorum brevis muscle flaps, 3 abductor hallucis flaps, 7 latissimus dorsi flaps, 16 distal medialis flaps of leg pedicled with the cutaneous branch of posterior fibial artery, 2 foot dorsum flaps. Results\ All the flaps survived, primary healing of the wound in 45 cases and secondary healing in 1 case. Followed up for 3 months to 4 years, 43 patients obtained good flap sensation, the function of weight bearing were satisfied in 43 patients. Conclusion\ The six different flaps should be applied according to patient’s condition individually. The sensation of flap is very important to the function of weight bearing.