负压封闭引流技术联合游离背阔肌肌皮瓣修复足踝部大面积软组织缺损

Clinical application of vacuum sealing drainage and free latissimus dorsal muscular flap to repair the large soft tissue defect in foot and ankle region

目的探讨持续负压封闭引流(vacuum sealing drainage,VSD)技术联合游离背阔肌肌皮瓣治疗足踝部大面积软组织缺损的临床疗效。方法选取我院自2013年5月至2017年7月应用VSD联合游离背阔肌肌皮瓣治疗26例足踝部大面积软组织缺损患者,均合并骨或肌腱等深部组织裸露或部分缺损。所有患者入院后一期行清创+VSD覆盖术,待创面清洁无感染后二期行游离背阔肌肌皮瓣移植术修复。结果术后随访4~18个月,平均12个月。移植皮瓣均成活,其中22例创面一期愈合;4例经局部换药或植皮后愈合。随访期内4例行皮瓣削薄术改善臃肿外形。所有皮瓣均未恢复保护性感觉。结论负压封闭引流技术联合游离背阔肌肌皮瓣修复足踝部大面积软组织缺损取得了满意的临床效果。

Objective To study the clinical effect of using vacuum sealing drainage（VSD）and free latissimus dorsal muscular flap to repair the large soft tissue defect in foot and ankle region.Methods From May 2013 to July 2017,26 cases of large soft tissue defect of foot and ankle region which accompanied tendon or bone exposure were treated with VSD and free latissimus dorsal muscular flap transplantation.All patients were admitted to the first phase of debridement＋VSD coverage,and then the following two stages of free latissimus dorsal latissimus muscle flap transplantation was repaired when the wound was clean.Results Postoperative follow-up was 4-18 months,with an average of follow-up period of 12 months.The graft flaps were all alive,and 22 of them were healed by first intention.four cases healed after local administration or skin grafts.During the followup period,4 routine flaps were used to improve the appearance of bloat.No protective sensation was restored in all flaps.Conclusion The using of VSD and free latissimus dorsal muscular flap to repair the large soft tissue defect in foot and ankle region can achieve satisfactory clinical results.