两种皮瓣治疗足踝部软组织缺损的效果对比

Comparation of Clinical Application Between Two Operations of Neurocutaneous Island Flap on Reconstruction of Soft Tissue Defects in Foot and Ankle

目的 探讨腓肠神经营养血管逆行岛状皮瓣和隐神经营养血管逆行岛状皮瓣在治疗足踝部软组织缺损时的临床疗效以及区别.方法 回顾性研究2015-2018年我院足踝部软组织损伤行两种皮瓣治疗的患者,其中行腓肠神经营养皮瓣（A组）24例,隐神经营养皮瓣（B组）19例,测量术中伤口大小以及所取皮瓣的长度和宽度,随访术后3-6个月皮瓣的成活率、血液循环、感觉恢复、负重行走、外形是否异常,以及供区是否有相应并发症等,并进行评分.结果 腓肠神经营养血管逆行岛状皮瓣和隐神经营养血管逆行岛状皮瓣在成活率上无差异,分别为95.8％和94.7％,P〉0.05;修复面积、功能和术后并发症无明显差异,腓肠神经营养血管逆行岛状皮瓣最低旋转点至跟骨结节平均距离为7.2 cm,隐神经皮瓣组为8.7 cm,P〈0.05;两者有统计学差异.结论 腓肠神经营养血管逆行岛状皮瓣和隐神经营养血管逆行岛状皮瓣都是修复足踝部软组织缺损的良好方法,两者在修复面积和修复成功率上无明显差异,但腓肠神经皮瓣最低旋转点低,如果伤口靠近足跟甚至中足,可优先考虑腓肠神经营养血管逆行岛状皮瓣,而隐神经营养血管皮瓣供区位于小腿内侧更适宜修复小腿中、下段前内侧和内踝以及足背等处的组织缺损,两者相互补充.

Objective To discover the clinical application and compare the clinical effect between reversed sural neurocutaneous island flap and reversed saphenous neurocutaneous island flap on reconstruction of soft tissue defects in foot and ankle. Methods From September 2015 to March 2018,43 cases of soft tissue defects in foot and ankle of our hospital were including for restore by using cutancous flap. 24 cases were treated with sural nearocutaneous fascio- cutaneous flap,while the other 19 cases were fixed by reversed saphenous neurocutaneous island flap. All the cases were followed up postoperatively after 3 -6 months. Comparative study of reconstruction outcomes, coverage, patient- satisfaction with flap appearance and donor - site morbidities were performed between the groups. Results Survival rate and reparation of wound between the sural neurocutaneous flap and saphenous neurocutaneous flap is no signifi- cant difference. Quality of flap and functional results at receiving site were similar for both groups. But the rotating point of sural neurocutaneous flap is lower than that of saphenous neurocutaneous flap in the same state（ P 〈 0.05 ）. Conclusion Both reversed sural neurocutaneous flap and reversed saphenous neurocutaneous island flap are relatively ideal operative methods to solve the soft tissue defects in foot and ankle. If the soft tissue defect of the foot and ankle is concentrated to the midfoot, the reversed sural neurocutaneous island flap can be given priority while the donor site of reversed saphenous neurocutaneous island flap is located on the medial side of the lower leg and is more suitable for repairing tissue defects in the medial and lower leg anterior medial, also in medial malleolus and the dorsal foot.