负压封闭引流联合游离胫后动脉串联皮瓣修复前足脱套伤

Vacuum sealing drainage and free coupling chain-link posterior tibial artery flap in the reconstruction of degloving injury of propodium

目的探讨应用负压封闭引流技术联合游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤的方法和临床效果。方法2008年10月至2011年12月，一期应用负压封闭引流技术处理创面，延期应用带神经的游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤5例。皮瓣切取面积为：胫后动脉皮瓣14cm×10cm～11cm×8cm，足底内侧皮瓣12cm×8cm～8cm×6cm。结果本组5例皮瓣全部成活，无血管危象发生。术后随访6～21个月，感觉恢复s3～s3＋级，皮瓣质地、外形均良好，跖底无溃疡及胼胝发生。结论应用负压封闭引流技术联合带神经的游离胫后动脉皮瓣串联足底内侧皮瓣瓦合修复前足脱套伤，是一种有效可行的方法。

Objective To present the methods of vacuum sealing drainage and free coupling chain-link flap of posterior tibial artery flap and medial plantar flap in the reconstruction of degloving injury of propodium. Methods From Oct. 2008 to Dec. 2011 five cases with degloving injury of propodium underwent debridement and vacuum sealing drainage on the first stage. Free chain-link flap of posterior tibial artery flap and medial plantar flap were applied to close the wound at the secondary stage. The nerve was included in the coupling flaps. The size of posterior tibial artery flap ranged from 14 cm×10 cm to 11 cm×8 cm,and the size of medialplantar flap ranged from 12 cm×8 cm to8 cm×6 cm. Results All flaps were survived with no vascular crisis. The flap sensation recoverd to S3-S3＋ during the follow-up period of 6-21 months. The texture and appearance of flaps were satisfied. The plantar had not ulcer and corpus callosum. Conclusion Vacuum sealing drainage and free chain-link flap of posterior tibial artery flap and medial plantar flap with nerve are the ideal methods for the reconstruction of degloving injury of propodium.