选择不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损

Choosing of the posterior lateral leg pedide skin flaps supplyed by different blood repair of foot and ankle soft tissue defect

目的探讨根据足踝部皮肤缺损的特点选择不同供血方式的小腿后外侧带蒂皮瓣修复足踝部缺损治疗效果。方法2001年1月-2015年12月，收治足踝部皮肤软组织缺损163例。①采用腓肠神经营养血管皮瓣修复足踝部软组织缺损93例。②采用腓动脉穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损36例。③采用感觉重建的腓动脉穿支蒂腓肠神经营养血管皮瓣修复足跟部软组织缺损16例。④采用腓动脉穿支皮瓣修复前踝、外踝、后踝软组织缺损10例。⑤采用腓动脉及穿支供血为蒂的腓肠神经营养血管皮瓣修复前足背软组织缺损8例，供区创面植皮修复。结果腓肠神经营养血管皮瓣93例中有8例部分坏死，经换药创面愈合。腓动脉穿支蒂腓肠神经营养血管皮瓣全部成活。感觉重建的腓动脉穿支蒂腓肠神经营养血管皮瓣修复足跟部软组织缺损，末次随访根据1 954英国医学研究委员会感觉分级标准进行感觉功能评定，感觉测定大于S0，小于S1；腓动脉穿支皮瓣全部成活；腓动脉及穿支供血的腓肠神经营养血管皮瓣有1例皮瓣远端表皮坏死，经换药愈合。术后随访6~50个月，平均20个月，所有患者恢复正常行走功能，术前感染创面术后均无复发。结论对于足踝部软组织缺损，根据创面的位置、大小、损伤程度及周围血管的情况，选择最为简单、安全、损伤最小的皮瓣修复。正确的选择、精确的设计可以提高瓣成活率，获取良好的临床效果。

Objective According to the characteristics of skin defects in ankle and foot select the posterior lateral leg pedide skin flaps supplyed by different blood to repair, providing advice and reference. Methods Between January, 2001 and December, 2015, 163 cases of soft tissue defects at the foot and ankle were treated in our department. ①The sural neurovascular flap was used in 93 cases in ankle and foot defect. ②The sural nerve nutritional vessel flap pediele with the perforating branch of the peroneal artery in 36 cases in ankle and foot defect. ③The sural nerve nutritional vessel flap pediele with the perforating branch of the peroneal artery including sensory reconstruction in 16 cases in heel rejion defect. ④Peroneal artery perforator flap in 10 cases in anterior ankle, lateral malleolus and posterior malleolus defect. ⑤The use of the sural fasciocutaneous flap alonged with peroneal artery and perforators in 8 cases in dorsal foot defect. The donor site with skin graft. Results Of the 93 sural neurovascular flaps, 8 had partial loss, which were cured after dressing. All the sural nerve nutritional vessel flaps pediele with the perforating branch of the peroneal artery survived. Sensory grading standard by UK Medical Research Council was used to evaluate the recovery of sensory function on the last follow-up. The sensory function recovery of heel region flaps with reconstruction of the sensory was between So and S1. All peroneal artery perforator flaps survived. One of the sural fasciocutaneous flap alonged with peroneal artery and perforators occurred distal epidermis, which were cured after dressing. All patients were followed up 6-50 months （mean 20 months）. All patients had recoveryed walking function, and infection wound had no recurrence after surgery. Conclusion According to the location, size, severity and the injury of peripheral vascular, select the most simple, safe, minimal damage flap for the soft tissue defects at the foot and ankle. The right choice and the exact design can improve flap survival rate, and recieve good clinical results.