高能量损伤致足踝部软组织缺损的创面修复

Repair of soft tissue defect caused by high energy injury in foot and ankle region using different flaps

目的探讨不同种类皮瓣修复高能量损伤致足踝部软组织缺损的技术要点和临床疗效。方法以腓动脉穿支为远端蒂的腓肠神经营养血管皮瓣修复踝周前外侧、足背近端、足跟外侧创面19例，以胫前动脉穿支为远端蒂的腓浅神经营养血管皮瓣修复踝周前内侧、足背部、足跟内侧创面10例，以腓动脉的终末穿支为远端蒂的外踝上皮瓣修复外踝部、足背近端创面5例，以足底内侧皮瓣修复足跟底部负重区创面3例。结果本组34例皮瓣完全成活．1例皮瓣远端表皮坏死，2例皮瓣远端部分坏死，经局部换药后痊愈，未再次手术。术后随访6-12个月，成活皮瓣外观、质地和厚度与足踝部受区相似，负重区无溃疡发生，有保护性感觉，两点辨别觉5-10mm。结论根据病情合理选择不同种类皮瓣修复足踝部软组织缺损可有效提高皮瓣成活率并重建肢体功能。

Objective To study the technical principle and clinical effect of different flaps which were used to repair the soft tissue defect caused by high energy injury in foot and ankle region. Methods The soft-tissue defects in the anterolateral ankle, proximal dorsum pedis and lateral heel were repaired by sural neurocutaneous flaps based on the distal pereneal perforators in 19 cases. The soft-tissue defects in the anteromedial ankle, dorsum pedis and medial heel were repaired by superficial pereneal neurocutaneous flaps based on the distal perforators of anterior tibial artery in 10 cases. The soft-tissue defects in the external malleolus and proximal dorsum pedis were covered by lateral supramalleolar flaps based on the distal pereneal perforators in 5 cases. The soft-tissue defects in the loading area of heel were repaired by medial plantar flaps in 3 cases. Results Of the 37 patients, 34 achieved complete survival of the flaps, 1 developed an epidermal necrosis over the distal part, and 2 developed necrosis over the distal part. The wound healing was achieved after dressing change and additional operation was not performed. The follow-up duration ranged from 6 to 12 months. There was no difference in the appearance, texture and contour between the flaps and receptor in foot and ankle region. The flaps had no ulcer occurred and good protective sense. The two point discrimination of the flap was 5 to 10 mm. Conclusion It is important to make reasonable evaluation and choice of the different flaps to repair the soft tissue defects in foot and ankle region in order to elevate the survival rate of the flaps and reconstruct limb function.