可转换交腿方式的远端蒂腓肠神经营养血管皮瓣修复对侧足背前端较大创面

Clinical application of changeable cross-leg style sural neurovascular flap in repairing contralateral fairly large soft tissue defect on dorsum of forefoot

目的探讨可转换交腿方式的远端蒂腓肠神经营养血管皮瓣交腿修复对侧足背前端较大创面的疗效。方法2006年6月—2015年6月,收治12例足背前端较大创面患者。男8例,女4例;年龄18~57岁,平均35.6岁。外伤10例,其中交通事故伤4例、机器挤压伤3例、重物砸伤3例,伤后至就诊时间5 h^28 d,中位时间11 d;萎缩性瘢痕溃烂2例,病程分别为2年及3年。创面范围为6.2 cm×4.1 cm^11.5 cm×7.4 cm;均伴肌腱外露,6例合并骨外露。应用远端蒂腓肠神经营养血管皮瓣交腿修复创面,通过增加蒂部宽度从而增加蒂部长度,并用网状弹性绷带包扎固定,使术后患者双下肢可自行在上、下交腿与平行交腿之间转换。皮瓣切取范围为16 cm×7 cm^21 cm×11 cm;蒂长8~16 cm,宽5~6 cm。结果术后10例皮瓣顺利成活,创面Ⅰ期愈合;2例皮瓣边缘出现暗紫,经对症处理后成活。治疗期间均无压疮发生。患者均获随访,随访时间3~24个月,平均7个月。患肢外形及功能恢复较好,皮瓣质地、颜色良好,耐磨损。结论可转换交腿方式的远端蒂腓肠神经营养血管皮瓣交腿修复足背前端较大创面,可有效避免单一交腿方式导致的不适以及易发生压疮等不足,临床疗效良好。

Objective To explore the effectiveness of changeable cross-leg style sural neurovascular tlap in repairing contralateral fairly large soft tissue defects on dorsum of forefoot. Methods Between June 2006 and June 2015, 12 patients with fairly large soft tissue defect on dorsum of forefoot were treated. There were 8 males and 4 females, with an average age of 35.6 years （range, 18-57 years）. Defects were caused by traffic accident injury in 4 cases, machine crush injury in 3 cases, and heavy object crush injury in 3 cases, with a median disease duration of 11 days （range, 5 hours to 28 days） in the 10 cases; the defect cause was atrophic scar in 2 cases, with disease duration of 2 years and 3 years respectively. The wound size of soft tissue ranged from 6.2 cm×4.1 cm to 11.5 cm×7.4 cm; combined injuries included tendon exposure in all cases and bone exposure in 6 cases. The changeable cross-leg style sural neurovascular flaps were used to repair defects. The width and length of flap pedicle were increased. The cross-leg position was maintained with the elastic net bandage. The size of flaps was 16 cm×7 cm to 21 cm×ll cm, with a pedicle of 8-16 cm in length and 5-6 cm in width. Results After operation, 10 flaps survived, and wound healed by first intention. Extravasated blood occurred at the flap edge in 2 cases and was cured after symptomatic treatment. No pressure sore occurred. All patients were followed up 3-24 months （mean, 7 months）. The appearance and function of the affected legs were good, and the flaps had soft texture and normal color. Conclusion Changeable cross-leg style sural neurovascular flap can achieve good effectiveness in repairing fairly large soft tissue defect on dorsum of forefoot. Some drawbacks of single cross-leg style can be avoided.