下肢皮神经营养血管皮瓣修复儿童足跟部开放损伤

Lower extremity neurocutaneous vascular flap for repair of children' s heel open injury

目的：探讨下肢腓肠神经营养血管皮瓣及隐神经营养血管皮瓣逆行转移修复儿童足跟部开放损伤的效果。方法36例足跟部开放损伤患儿均一期清创,其中8例踝关节脱位复位克氏针固定；均行负压封闭引流（ VSD）覆盖创面。二期手术根据创面位置25例采用腓肠神经营养血管皮瓣,11例采用隐神经营养血管皮瓣逆行转移覆盖软组织缺损创面。结果25例腓肠神经营养血管皮瓣术后7例出现不同程度的张力性水疱,经换药后愈合；4例皮瓣与创面边缘延迟愈合。11例隐神经营养血管皮瓣中2例出现不同程度的张力性水疱,经换药后愈合。36例均获随访,时间2～26个月。皮瓣血运均良好,色泽接近正常,但皮瓣感觉差。按Amer-Lindholm评定方法：优22例,良9例,差5例,优良率86.1%。结论儿童足跟部开放损伤根据病情选择下肢腓肠神经营养血管皮瓣或隐神经营养血管皮瓣逆行转移修复创面,可以取得满意的效果。

Objective To investigate the effects of repair of children’s heel open injury by retrograde metastasis res-toration of the lower extremity sural neuro flap and saphenous neurocutaneous vascular flap. Methods Of all the pri-mary debridement of 36 cases of children’s heel open injury, 8 cases were for treating ankle joint restoration with Kir-schner wire fixation and by covering the wound surface with vacuum sealing drainage （ VSD） . In the second-stage op-eration and on the basis of wound surface location, 25 cases were treated with sural neuro flap, 11 cases were retro-grade metastasis of covering soft tissue coloboma on the wound surface with sural neuro flap. Results Of all the 25 after sural neuro flap operations, tension blisters of varying degrees occured on 7 cases, but wound healed up after changing the fresh dressing. 4 cases of skin flap with the edges of the wound got delayed heelin. Of the 11 cases of saphenous neurocutaneous vascular flap, tension blisters of varying degrees occured on 2 cases and wound healed up after changing the fresh dressing. All the 36 children were followed up with periods of 2 to 26 months. All the flap blood supply were normal with approximate skin color but with less flap sensory. By Amer-Lindholm evaluation meth-od：the results were excellent in 22 cases, good in 9 and poor in 5, excellent and good rate was 86. 1%. Conclusions Of all the cases of children’s heel open injury, satisfactory results can be achieved by applying retrograde metasta-sis restoration for wound surface with the lower extremity sural neuro flap and saphenous neurocutaneous vascular flap according to the states of the patients.