不同节段的穿支蒂腓肠神经营养血管皮瓣修复下肢缺损

Utility of different levels of perforator-based sural neurofasciocutaneous flaps in repairing lower limb defects

目的:探讨不同节段的穿支蒂腓肠神经营养血管皮瓣修复下肢缺损的适应证和临床效果。方法:2004年至2012年治疗13例下肢软组织缺损患者,男8例,女5例;年龄15～76岁,平均38.6岁。采用3种不同节段的穿支蒂腓肠神经营养血管皮瓣进行修复,包括外踝尖后上4～7cm处腓动脉穿支蒂腓肠神经营养血管皮瓣修复足、踝部缺损8例;外踝尖后上9～11cm处腓动脉穿支蒂腓肠神经营养血管皮瓣修复小腿下段缺损3例;外踝尖后上1～2cm处外踝后动脉穿支蒂腓肠神经营养血管皮瓣修复足跟缺损2例。皮瓣切取面积为4.5cm×2.5cm～16cm×10cm。供瓣区创面移植皮片修复。结果:13例皮瓣术后均未发生血管危象及切口感染,皮瓣均顺利成活,切口均Ⅰ期愈合。8例患者获得随访,时间1～12个月,平均6个月,皮瓣色泽、质地良好,厚薄适中,无烫伤及溃疡发生;供、受区外形及功能恢复较为满意。结论:灵活选用不同节段的穿支蒂腓肠神经营养血管皮瓣修复下肢缺损,可获得理想效果。

Objective：To investigate the indications and effects of different levels of perforator based sural neurofasciocu-taneous flaps in repairing lower limb defects. Methods：From 2004 to 2012,13 cases of soft tissue defects of lower extremity were successfully reconstructed using different levels of perforator-based sural neurofasciocutaneous flaps ,included 8 males and 5 females with an average age of 38.6 years old ranging from 15 to 76 years old. Perforator based sural neurofasciocuta-neous flaps located at 4 to 7 cm above the tip of the lateral malleolus were used to resurface ankle and foot defects in 8 cases , perforator-based sural neurofasciocutaneous flaps located on 9 to 11 cm above the tip of the lateral malleolus were used to resurface lower third leg defects in 3 cases,as well as perforator based sural neurofasciocutaneous flaps located on 2 cm above the tip of the lateral malleolus were used to repair heel defects in 2 cases. The area of the transferred flaps ranged from 4.5 cm× 2.5 cm to 16 cm×10 cm. The donor sites were covered with skin grafts. Results：All the flaps survived uneventfully with primary healing. Eight patients were follow up for 1 to 12 months with an average of 6 months. The color, luster and texture of flap were good, thickness of flaps was fair. No empyrosis and ulcer occurred. The contour and function were satisfied with both the donor and recipient site. Conclusion：Satisfactory functional results can be achieved by using different segment of perforator based sural neurofasciocutaneous flaps for repairing lower extremity defects.