改良腓肠神经营养血管逆行皮瓣修复踝部组织缺损中的临床运用

Modified retrograde sural neurofasciocutaneous flap for treating the soft tissue defect of ankle

目的探讨改良腓肠神经营养血管肌皮瓣逆行修复踝部软组织缺损并重建皮瓣感觉功能的临床效果。方法 2010年3月～2014年3月对13例足踝部软组织缺损的病例,采用改良逆行腓肠神经营养血管肌皮瓣转移方法,将皮瓣旋转点改为外踝上5cm,根据创面大小及最远端距离调整旋转点位置,筋膜蒂宽度在3～5cm,将腓肠神经与小隐静脉包含在蒂内,采用明道转移修复创面。结果 13例中11例完全存活,2例皮瓣远端皮肤部分坏死,经换药瘢痕愈合。随访6～24个月,平均15个月,皮瓣质地优良,无局限性臃肿,感染治愈均无复发。结论改良带腓肠神经营养血管逆行岛状皮瓣修复足、踝部皮肤缺损不需吻合血管,操作简便,安全可靠,是修复足踝部皮肤缺损的理想皮瓣。

Objective To evaluate the clinical effect of modified retrograde sural neurofasciocutaneous flap for treating the soft tissue defect of ankle. Methods From Mar. 2010 to Mar. 2014,13 cases of soft tissue defect at the lower leg and ankle were repaired with retrograde sural neurofasciocutaneous flap modified by harvesting a patch of gastrocnemius muscle simultaneously. The flap rotation point was 5 cm superior to the external ankle and the accurate location was adjusted according to the size of the wound and the distance to the far end. The width of the fascial pedicle was 3 to 5 cm including the sural nerve and small saphenous vein into the flap,with an open tunnel for the transferred fascial pedicle. Results All of the 13 cases were followed up for 6-24 months,11 cases survived totally,and 2 cases had partial necrosis at the distal part,which healed secondarily after dressing change. All the flaps had good quality,satisfactory appearance,and the defects with infection were cured without recurrence. Conclusion Modified retrograde sural neurofasciocutaneous flap is a favourable choice for soft tissue defect in lower leg and ankle for its reliable blood supply,strong anti-infection ability,good appearance and easy operation.