游离胸脐皮瓣治疗复杂足踝部大面积皮肤软组织缺损

Free thoracoumbilicus flap for repairing severe skin and soft tissue defect of foot and ankle

目的探讨游离胸脐皮瓣移植修复复杂足踝部大面积皮肤软组织缺损创面的疗效。方法分析2009年1月—2015年1月,采用游离胸脐皮瓣移植修复的复杂足踝部大面积皮肤软组织缺损创面病例共25例,其中男性13例,女性12例;年龄19~64岁,平均38.3岁。创面缺损部位:足内侧+内踝4例,足背+踝关节10例,足外侧+外踝6例,足底+足内侧5例;创面缺损面积:16cm×12cm^36cm×14cm;所有病例均在骨折固定、创面无明显感染下进行。所有病例均于术后4周在支具保护下行早期康复训练,术后半年依据情况行皮瓣修整术,进一步改善患肢外观及功能。结果术后随访9~22个月,平均14.2个月;皮瓣全部成活,仅2例皮瓣边缘小面积坏死,经换药、清创、植皮等治疗后完全愈合;创面愈合时间12~34d,平均17.1d;术后皮瓣面积无明显回缩,色泽与受区相似,供区瘢痕挛缩不明显;根据Maryland足功能评定标准,优22例,良3例。结论游离胸脐皮瓣移植修复复杂足踝部大面积皮肤软组织缺损创面,皮瓣可切取面积大且易于切取,能够最大限度地保存足部残余功能,降低截肢率。

ObjectiveTo investigate the clinical effect of free thoracoumbilicus flap for repairing severe skin and soft tissue defect at foot and ankle.MethodsFrom Jan.2009to Jan.2015,25patients suffering from large area skin and soft tissue defect wound at foot and ankle were treated with transplantation of the free thoracoumbilicus flap.There were13males and12females,with an average age of383years(range,1964years).Of all the patients,4cases had defect wound at inner foot and malleolus,10at dorsum of foot and ankle,6at external foot and malleolus,and5at inner foot and planta.The wound defect area ranged from16cm×12cm to36cm×14cm.All the patients accepted transplantation of free thoracoumbilicus flap after fracture fixation and no infection.After4weeks,postoperative rehabilitative exercise was taken under the protection of orthosis.To improve the appearance and function of the foot and ankle,plastic surgery of flaps were performed half a year later according to the condition of each flap.ResultsAll the cases were followed up for9to22months(average,142months).All the flaps survived,except mild necrosis on the edge in2flaps.Through wound dressing,debridement,skin grafting,all flaps had good healing without any leakage.The healing process lasted for12to34d(average,171d).The color of flaps was similar to the recipient site without any retraction and scar contracture.According to Maryland’s scale,the surgery function was assessed,showing excellent in22cases and good in3cases.ConclusionDue to its easy access and wide coverage,it is recommended to repair the large area skin and soft tissue defect wound at foot and ankle with free thoracoumbilicus flap,which could significantly preserve the residual function of foot,and reduce the amputation rate.