腓肠神经营养腓动脉穿支复合组织瓣修复足底负重区软组织缺损的临床应用

CLINICAL APPLICATION OF SURAL FASCIOMYOCUTANEOUS PERFORATOR FLAP IN REPAIR OF SOFT TISSUE DEFECT IN WEIGHT-BEARING AREA OF FOOT

目的总结腓肠神经营养腓动脉穿支复合组织瓣修复足底负重区软组织缺损的临床效果。方法2007年1月-2010年9月,采用腓肠神经营养腓动脉远端穿支蒂皮瓣并保留部分腓肠肌修复19例足底负重区软组织缺损患者。其中男13例,女6例;年龄19~58岁,平均41.3岁。致伤原因:交通事故伤16例,机器压轧伤3例。受伤至入院时间2 h^14 d。软组织缺损范围8 cm×6 cm^26 cm×16 cm;皮瓣切取范围7 cm×7 cm^25 cm×12 cm。供区植皮修复。术后观察皮瓣成活情况,评价受区疼痛及感觉恢复情况。结果术后1例发生皮瓣远端坏死,二次清创后全厚皮片植皮成活;余18例皮瓣完全成活,创面Ⅰ期愈合。供区植皮均成活,切口Ⅰ期愈合。1例患者于完全负重5周后出现皮瓣边缘溃疡,经换药及避免负重2周后溃疡愈合。19例均获随访,随访时间9~25个月,平均14.1个月。皮瓣外观及质地良好,蒂部无臃肿。末次随访时分别有17例(89.4%)患者的浅感觉及18例(94.7%)患者的深感觉恢复。结论腓肠神经营养腓动脉穿支复合组织皮瓣是一种修复足底负重区软组织缺损的可靠方法,具有耐磨、溃疡发生率低及感觉恢复快等优点。

Objective To assess the effectiveness of the sural fasciomyocutaneous perforator flap in repair of soft tissue defect in weight-bearing area of the foot.Methods Between January 2007 and September 2010,19 patients with soft tissue defects in the weight-bearing area of the foot were treated with sural fasciomyocutaneous perforator flaps.The etiology was traffic accident in 16 patients and crush injury in 3 patients.The interval of injury and admission was 2 hours to 14 days.The size of defect ranged from 8 cm × 6 cm to 26 cm × 16 cm;the size of flap ranged from 7 cm × 7 cm to 25 cm × 12 cm.The donor sites were repaired by free skin graft.The flap survival was observed after operation,and the pain score and sensory recovery at the recipient site were used to assess the effectiveness.Results The flaps survived with satisfactory aesthetic and functional results in 18 cases.Partial flap necrosis was noted and second healing was achieved after split thickness skin grafting in 1 case.One case of delayed ulceration was also noted after 5 weeks,ulceration was successfully cured after wound care and avoidance of weightbearing for 2 weeks.All patients were followed up 9-25 months（mean,14.1 months）.The flaps had good appearance,without bulky pedicle.Superficial sensation and deep sensation were restored in 17 cases（89.4%） and 18 cases（94.7%） respectively at last follow-up.Conclusion Sural fasciomyocutaneous perforator flap is a reliable modality in heel reconstruction,having the advantages of low ulceration rate,good wear resistance,and good sensation recovery.