腓肠神经营养血管皮瓣蒂部旷置法修复小腿下段踝部及足部创面的临床效果

The clinical analysis of curative effect of sural neurovascular flap pedicle exclusion on repairing wound on lower segment leg and foot

目的探讨腓肠神经营养血管远端蒂皮瓣旷置在修复小腿下段踝部及足部创面的临床效果。方法回顾性分析2005年4月～2014年12月我院应用腓肠神经营养血管远端蒂皮瓣修复小腿、踝部及足部创面187例的临床资料，将187例患者随机分成观察组93例和对照组94例。观察组通过个体化设计，根据皮瓣周围组织量大小，蒂部进行旷置处理，二期修复创面；对照组按照常规处理，一期修复蒂部创面。观察两组患者的皮瓣存活率、皮瓣肿胀持续时间、皮瓣坏死面积、皮瓣质地、痛觉等并进行对比分析。结果观察组皮辫存活率（L=94．62％），差异有统计学意义（P〈0．05）皮瓣肿胀持续时间T（3．87±0．25）天，差异有统计学意义（P〈0．05）；皮瓣坏死面积（S2．67％），差异无统计学意义（P〉0．05），两组皮瓣质地比较，差异无统计学意义（P〉0．05），两组痛觉比较，差异有统计学意义（P〈0．05）。结论腓肠神经营养血管远端蒂皮瓣旷置法修复小腿下段、踝部及足部创面对于一期闭合蒂部创面而言，能显著提高皮瓣的成活率并减轻肿胀程度，改善临床疗效。

Objective To analyze the curative effect of sural neurovascular flap pedicle exclusion on repairing wound on lower segment leg and foot. Methods 187 patients with repairing wound on lower segment leg and foot were divided into observation group and control group. The observation group and control group included 93 cases and 94 ca- ses. The survival rate of flap, duration of swelling, necrosis areas,texture and pain were observed. Results The differ- ence was significant in flap survival rate （ L=94.62 %, P〈0.05） and swelling of the skin flap duration （$2.67%, P（ 0.05） between observation group and control group. Flap necrosis area and texture were not statistically significant between observation group and control group （P〉0.05）. Pain in both groups had significant difference （P〈0.05）. Conclusion The method of flap pedicle exclusion can improve the survival rate of skin flap, reduce swelling and improve the clinical curative effect.