携带腓肠肌的腓动脉穿支腓肠神经营养血管双血供复合组织瓣修复足踝部腔隙性缺损的临床效果

Clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar defect of ankle

目的探讨携带腓肠肌的腓动脉穿支腓肠神经营养血管双血供复合组织瓣修复足踝部腔隙性皮肤软组织缺损的临床效果。方法2015年9月—2017年9月,笔者单位收治10例踝部腔隙性皮肤软组织缺损患者,其中男7例、女3例,年龄17~62岁,交通事故伤8例、重物压伤2例,清创后创面面积7cm×4cm^15cm×9cm、腔隙大小3.0cm×2.0cm×1.0cm^7.0cm×4.0cm×2.0cm。采用同时保留腓动脉穿支及腓肠神经营养血管并携带部分腓肠肌的岛状复合组织瓣Ⅰ期修复缺损,皮瓣面积为8cm×5cm^16cm×10cm、腓肠肌肌瓣面积为4cm×3cm^8cm×5cm。供瓣区取同侧大腿外侧中厚皮移植修复或直接拉拢缝合。记录血管蒂位置、组织瓣成活情况、随访情况、并发症发生情况。结果本组病例血管蒂位于外踝上5~15cm。10例患者组织瓣Ⅰ期术后完全成活。随访1~12个月,组织瓣修复处色泽、血运、质地良好,无破溃,恢复了不同程度的痛觉与深触觉,无近期或远期并发症发生。结论携带腓肠肌的腓动脉穿支腓肠神经营养血管双血供复合组织瓣血供良好,修复足踝部腔隙性皮肤软组织缺损可有效填塞无效腔,术后效果较好,值得临床推广应用。

Objective To explore the clinical effect of double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle in repairing lacunar skin and soft tissue defect of ankle.Methods From September 2015 to September 2017,10 patients with lacunar skin and soft tissue defects of ankle were hospitalized in our unit,including 7 males and 3 females,aged 17-62 years,8 traffic accident injuries and 2 heavy body pressure injuries.After debridement,the wound area ranged from 7 cm×4 cm to 15 cm×9 cm,and the lacunar area ranged from 3.0 cm×2.0 cm×1.0 cm to 7.0 cm×4.0 cm×2.0 cm.The defect was repaired with island composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel and partial gastrocnemius muscle at stageⅠ.The area of flaps ranged from 8 cm×5 cm to 16 cm×10 cm,and the area of gastrocnemius muscle flaps ranged from 4 cm×3 cm to 8 cm×5 cm.The donor site was repaired with ipsilateral thigh intermediate split-thickness skin graft or sutured directly.The location of vascular pedicle,survival of tissue flap,follow-up,and occurrence of complications were recorded.Results The vascular pedicle of this group of cases was located 5-15 cm above the lateral malleolus.The tissue flaps of 10 patients survived completely after operation at stageⅠ.Follow-up for 1-12 months showed that the area repaired with tissue flaps had good color,blood supply,and texture,without ulceration,and recovered different degrees of pain sensation and deep tactile sensation,and no short-term or long-term complications occurred.Conclusions The double blood supply composite tissue flap with peroneal artery perforator and sural nerve nutrient vessel carrying gastrocnemius muscle has good blood supply,which can effectively fill the invalid space in repairing lacunar skin and soft tissue defect of ankle,with good effect after operation,and it is worthy of clinical application.