腓肠神经营养血管皮瓣及足底内侧皮瓣治疗足跟部软组织缺损的疗效观察

Curative Effect of Sural Neurovascular Flap and Medial Plantar Flap on Soft Tissue Defect of Heel

【目的】分析对腓肠神经营养血管皮瓣及足底内侧皮瓣治疗足跟部软组织缺损的临床疗效.【方法】回顾性分析本院收治的42例足跟部软组织缺损患者的临床资料,其中采用足底内侧皮瓣修复25例(足底皮瓣修复组),腓肠神经营养血管皮瓣修复17例(腓肠肌皮瓣修复组).比较两组皮瓣修复面积、出院时Fugl-Meyer下肢运动功能评分,并随访观察创面愈合、皮瓣存活及并发症发生情况.【结果】足底皮瓣修复组术后并发症发生率为20.0%(5/25)显著低于腓肠肌皮瓣修复组的52.9%(9/17),差异具有统计学意义(χ^2=4.941,P=0.026<0.05).足底皮瓣修复组修复面积为(14.05±4.46)cm^2显著低于腓肠肌皮瓣修复组的(54.03±15.51)cm^2,差异具有统计学意义(t=12.229,P=0.00<0.05).两组出院时Fugl-Meyer下肢运动功能评分分别为(31.47±1.84)分、(30.10±3.23)分,差异无统计学意义(t=1.750,P=0.088>0.05).【结论】足底内侧皮瓣、腓肠神经营养血管皮瓣均是修复足跟部软组织缺损的较为理想的方法,但足底内侧皮瓣修复面积有限,则需要根据足跟部软组织缺损的具体情况选择合适的皮瓣,以达到更好的临床疗效.

【Objective】To analyze the clinical effect of sural neurovascular flap and medial plantar flap in the treatment of soft tissue defect of heel.【Methods】The clinical data of 42 cases with soft tissue defect of heel were retrospectively analyzed.25 cases were repaired with medial plantar flap(plantar flap repair group),17 cases were repaired with sural neurovascular flap(gastrocnemius myocutaneous flap repair group).The repair area of flaps and Fugl-Meyer lower limb motor function score at discharge were compared between the two groups,and the wound healing,survival of flaps and complications were observed.【Results】The incidence of complications in the plantar flap repair group was 20.0%(5/25),significantly lower than that in the gastrocnemius flap repair group 52.9%(9/17),and the difference was statistically significant(χ^2=4.941,P=0.026<0.05).The repair area of plantar skin flap group was(14.05±4.46)cm^2,which was significantly lower than that of gastrocnemius muscle skin flap group(54.03±15.51)cm^2(t=12.229,P=0.00<0.05).Fugl-Meyer lower extremity motor function score was(31.47i 1.84)and(30.10±3.23)respectively at discharge,but there was no significant difference between the two groups(t=1.750,P=0.088〉0.05).【Conclusion】Medial plantar flaps and sural neurovascular flaps are ideal methods for repairing soft tissue defect of heel.However,the repair area of medial plantar flaps is limited,so it is necessary to select appropriate flaps according to the specific situation of soft tissue defect of heel in order to achieve better clinical effect,specific conditions of heel soft tissue defect to achieve better clinical effect.