逆行腓肠神经营养血管肌皮瓣移植治疗慢性跟骨骨髓炎

Retrograde sural neurovascular flap transplantation for chronic calcaneal osteomyelitis

背景:跟骨骨髓炎治疗既要彻底消除骨髓炎感染灶,封闭创面,修复缺损软组织,又要恢复肢体正常形态,最大可能保护足的负重功能。由于腓肠神经营养血管肌皮瓣不损伤下肢的主要血管,且其旋转弧度大,血供恒定可靠,适于修复慢性跟骨骨髓炎创面。目的:观察逆行腓肠神经营养血管肌皮瓣治疗慢性跟骨骨髓炎的效果。方法:赣州市人民医院骨科2008年5月至2012年6月收治28例慢性跟骨骨髓炎患者,彻底清创后采用逆行腓肠神经营养血管肌皮瓣移位移植治疗,供区直接缝合23例,植皮覆盖5例。结果与结论:28例患者移植后逆行移位肌皮瓣全部成活,其中4例出现肌皮瓣远端皮缘部分坏死,均经换药后愈合;所有患者肌皮瓣无臃肿,质地优,外形满意,功能感觉良好,跟骨骨髓炎未见复发,无并发症发生,所有患者均恢复正常行走。提示逆行腓肠神经营养血管肌皮瓣是治疗慢性跟骨骨髓炎的一种有效可行的方法。

BACKGROUND： Calcaneal osteomyelitis treatment is necessary that not only eliminates foci of osteomyelitis, seals the wound, repairs soft tissue defects, but also restores normal body shape and protects weight-bearing foot function as much as possible. Sural neurovascular flaps cannot damage major blood vessels of the lower limbs and appears to have the large arc of rotation, constant and reliable blood supply, which are suitable for repair of chronic calcaneal osteomyelitis. OBJECTIVE： To study the operating method and clinical results of repairing chronic calcaneal osteomyelitis using retrograde sural neurovascular island flaps. METHODS： Totally 28 patients with chronic calcaneal osteomyeliti were treated with the distally-based sural musculocutaneous flap in the Department of Orthopedics, People＇s Hospital of Ganzhou, from May 2008 to June 2012. The donor defects were closed primarily in 23 patients and were resurfaced with the split-thickness skin graft in five patients. RESULTS AND CONCLUSION： All the musculocutaneous flaps survived completely in 28 cases, four of which got some distal necrosis of the skin flap, and cured by dressing. All the flaps had good shapes and well-function, and exhibited no recurrence of osteomyelitis. All patients were able to walk normally. These findings indicate that the retrograde sural neurovascular flap transplantation is effective and feasible for treatment of chronic calcaneal osteomyelitis.