腓动脉蒂复合组织瓣逆行转位治疗跟骨骨髓炎骨与软组织缺损

Retrograde transposition of composite tissue flap pedicled with peroneal artery to treat bone and soft tissue defects following calcaneal osteomyelitis

目的报告腓动脉蒂复合组织瓣逆行转位治疗跟骨骨髓炎骨与软组织缺损的疗效。方法回顾性分析自2008年1月至2015年1月应用腓动脉复合组织瓣逆行转位治疗的47例跟骨骨髓炎骨与软组织缺损的患者资料，男43例，女4例；年龄24～67岁，平均43．6岁；病灶清理后皮肤缺损2cm×2cm-5cm×5cm，骨缺损1．5cm×1．0cm×2．0cm～3．0cm×3．0cm×4．5cm。结果47例患者术后均获随访，时间6～72个月（平均25．2个月）。2例患者骨髓炎复发，47例患者均未二次植骨，但均恢复行走功能，组织瓣植皮区质地、颜色接近正常皮肤，组织瓣无明显臃肿，无穿鞋障碍，外观好。根据美国足踝外科协会的踝一后足评分为58—91分，平均76．6分；其中优7例，良32例，可8例。术后6个月内发现蹿趾屈曲挛缩畸形10例，无趾破溃现象，未手术干预。结论腓动脉复合组织瓣逆行转位治疗跟骨骨髓炎骨与软组织缺损疗效可靠，复发率低，足部外观好，值得临床推广。

Objective To report retrograde transposition of composite tissue flap pedicled with peroneal artery in the treatment of bone and soft tissue defects following calcaneal osteomyelitis. Methods During the period from January 2008 through January 2015, 47 patients with bone and soft tissue defects following calcaneal osteomyelitis were treated by retrograde transposition of composite tissue flap pedicled with peroneal artery. They were 43 men and 4 women, aged from 24 to 67 years（average, 43.6 years）. After radical focus debridement, the areas of skin defect ranged from 2 cm ×2 cm to 5 cm × 5 cm and the bone defects ranged from 1.5cm × 1.0cm × 2.0cmto3.0cm × 3.0cm × 4.5cm, Results All the 47 patients were followed up for 6 to 72 months （average, 25.2 months）. Relapse of osteomyelitis occurred in 2 cases but secondary bone graft was needed in none. All the patients recovered their walking function. The texture and color of the composite tissue flaps were similar to those of normal skin, without obvious swelling. The flaps appeared good and imposed no obstacle to wearing shoes. The ankles and hind feet of the patients scored from 58 to 91 points （average, 76, 6 points） according to the American Orthopaedic Foot and Ankle Society （AOFAS） evaluation system, giving 7 excellent, 32 good and 8 fair cases. Hallux flexion contracture without skin ulcer was observed in 10 cases 6 months after surgery, necessitating no surgical intervention. Conclusion Retrograde transposition of composite tissue flap pedicled with peroneal artery can effectively treat bone and soft tissue defects following calcaneal osteomyelitis, leading to a low recurrence rate and good foot appearance.