皮瓣修复踝关节周围软组织缺损的疗效观察

Clinical observation of ankle cutaneous defect repaired by flap prosthetics

目的：探讨应用外科皮瓣技术修复常见的踝关节周围软组织缺损的临床疗效。方法对2007-2014年收治的踝关节周围软组织缺损30例，行6种外科皮瓣技术修复，其中局部转移皮瓣7例，远端蒂腓肠神经皮瓣5例，远端蒂腓动脉皮穿支皮瓣6例，胫后动脉皮穿支皮瓣6例，逆行外踝上岛状皮瓣1例，游离股前外侧穿支皮瓣5例。切取皮瓣最小3 cm×3 cm，最大19 cm×9 cm。结果30例皮瓣中26例Ⅰ期全部成活；2例远端蒂腓肠神经岛状皮瓣远端部分坏死，经局部换药治疗后创面愈合；1例胫后动脉皮穿支皮瓣远端1/4部分坏死，经Ⅱ期植皮后闭合创面；1例远端蒂腓动脉皮穿支皮瓣术后出现静脉危象，行远端放血处理后，后期皮瓣皮肤脱痂愈合。随访3个月~5年，皮瓣质地好。结论应用皮瓣修复技术，可使骨科各类常见的踝关节周围软组织缺损创面得到满意的修复。

Objective To investigate the repair of ankle cutaneous defect with flap prosthetics. Methods There were 30 cases ankle cutaneous defect, who had been repaired with 6 kinds of skin flaps. Local gyral flap in 7 cases, distal sural neurocutaneous flap in 5 cases, distal perforators peroneal artery flap in 6 cases, posterior tibial artery perforators flap in 6 cases, reverse lateral supramalleolar island flap in 1 case, and free anterolateral femoral cutaneous flap in 5 cases. The dimensions of the flap ranged from 3 cm×3 cm to 19 cm ×9 cm. Results 26 cases were one-stage survival, 2 cases of distal sural neurocutaneous flap partly necrosised and healed after change dressings, 1 case of posterior tibial artery perforators flap distal 1/4 portion necrosised and healed after two stage skin-grafting, 1 case of distal perforators peroneal artery flap venous crisis occurred and healing under-scab after distal portion bleeding therapy. Conclusion The application of flap prothesis can cure kinds of ankle cutaneous defect nicely.