不同类型的皮瓣移植修复前足毁损伤研究

Study on different types of skin flaps for repairing damaged forefoot

目的探讨不同类型的皮瓣移植修复前足毁损伤的临床效果。方法选取2016年1月--2019年6月62例前足毁损伤患者,回顾性分析其临床就诊资料,所选患者均接受皮瓣移植修复治疗,其中26例患者行游离肌皮瓣移植修复,将其作为A组;其余36例患者给予足部逆行皮瓣移植修复,将其作为B组,对临床治疗方法及疗效进行总结。结果A组26例患者中,21例患者皮瓣完全成活,其余5例患者皮瓣边缘出现部分坏死表现,对其进行游离植皮处理,定期换药后愈合,所有患者皮瓣均成活;随访时间至少6个月,11例患者出现轻度跛行,皮瓣感觉稍差;B组36例患者中,术后仅有2例患者发生远端部分坏死,原因为足背皮瓣移植后出现较大张力,经过医师系统性处理及定时换药,2例患者皮瓣愈合;另有3例患者足内侧隐神经营养血管皮瓣出现静脉回流障碍现象,与肿胀因素相关,其余患者皮瓣均成活,愈合良好,未出现感染症状。结论结合前足毁损伤患者实际病情,制定皮瓣修复方法,近期和远期治疗效果均良好,在修复前足毁损伤中发挥重要作用。

Objective To investigate the clinical effect of different types of skin flaps for repairing damaged forefoot.Methods From January 2016 to June 2019,62 patients with forefoot injuries were selected.Their clinical data were retrospectively analyzed.All patients were treated with skin flap transplantation.26 of them were treated with free musculocutaneous flap transplantation as group A.The remaining 36 patients were treated with foot retrograde skin flap transplantation as group B.To summarize the clinical treatment and curative effect.Results Among the 26 patients in group A,21 cases survived completely,and 5 cases showed partial necrosis at the edge of the flaps.They were treated with free skin grafting,healed regularly after dressing change,and all the flaps survived.During a follow-up period of at least 6 months,11 cases had mild lameness,and 36 cases in group B had slightly poor sensation of the flaps.Among them,only 2 patients suffered from distal partial necrosis after operation,which was due to the large tension after dorsal pedal flap transplantation.After systematic treatment and regular dressing change,2 patients healed.Another 3 patients suffered from venous reflux disorder of medial saphenous nerve nutrient vessel flaps,which was related to swelling factors,while the other patients had skin defect.All the valves survived and healed well without any infection symptoms.Conclusion According to the actual condition of patients with forefoot injury,the method of skin flap repair is formulated.The short-term and long-term therapeutic effects are good,and it plays an important role in the repair of forefoot injury.