不同类型皮瓣修复足踝部软组织缺损的临床效果

Clinical effect of different types of flaps in repairing the soft tissue defects of foot and ankle region

目的探讨不同类型皮瓣修复足踝部软组织缺损的临床效果。方法对30例足踝部软组织缺损患者进行皮瓣修复,其中足底内侧皮瓣修复足跟部软组织缺损7例,股前外侧皮瓣修复足背、足内侧软组织缺损12例,腓肠神经营养血管皮瓣修复足踝部软组织缺损11例。结果患者均获得随访,时间1-5年。29例皮瓣完全成活,仅1例股前外侧皮瓣发生坏死,二次手术给予植皮。13例患者因皮瓣臃肿,二期行皮瓣修整术;2例患者因术后长期从事体力劳动足跟部发生溃疡;其余患者皮瓣质地柔软,踝关节功能恢复满意。供区均未出现并发症。足底内侧皮瓣修复患者皮瓣感觉功能完全恢复,股前外侧皮瓣修复患者感觉均部分恢复,5例吻合神经腓肠神经营养血管皮瓣患者于术后3-5个月感觉功能完全恢复,剩余患者感觉功能部分恢复。结论足底内侧皮瓣、股前外侧皮瓣、腓肠神经营养血管皮瓣各有优缺点,应根据足踝部软组织缺损面积、部位的不同选择合适的皮瓣,以提高皮瓣成活率,重建肢体功能。

Objective To investigate the clinical effects of different types of flaps in repairing the soft tissue defects of foot and ankle region. Methods Thirty patients of soft tissue defects of foot and ankle region were repaired with skin flap,7 cases of the soft tissue defect of heel were used medial plantar skin flap,12 cases of the soft tissue defects of dorsal and medial were used anterolateral thigh flap,11 cases of the soft tissue defects of foot and ankle region were used sural neurovascular flap. Results All patients were followed up for 1 - 5 years. Twenty-nine cases of flaps survived completely,only 1 case of anterolateral thigh flap occurred necrosis,secondary surgery to give skin graft. Thirteen cases received flap repairing surgery for bulky flap,2 cases occurred heel ulcers due to postoperative long-term manual labor,other patients flaps were soft,ankle function recovery were satisfactory,no donor site complications were appeared. The flap sensory function of medial plantar artery flap fully recovered,feels of the patients repaired with anterolateral thigh flap were partially restored,5 cases of nerve anastomosis sural neurovascular flap fully recovered sensory function in 3 - 5 months after surgery,sensory function in the remaining patients were with part of the recovery. Conclusions The medial plantar flap,the anterolateral thigh flap and the sural nerve nutrient vessel flap each have their advantages and disadvantages. According to preoperative ankle soft tissue defect area,the different parts of choosing the right flap,flap survival rate can be improved and eventually rebuilding physical features.