保留隐神经穿支的隐神经营养血管皮瓣修复足踝部软组织缺损

Application of saphenous neurovascular flap with the saphenous perforator nerve for the repair of the soft tissue defects of the ankle

目的:探讨保留隐神经穿支的隐神经营养血管皮瓣修复足踝部软组织缺损的临床疗效.方法:采用保留隐神经穿支的隐神经营养血管皮瓣修复足踝部软组织缺损15例,观察疗效.其中软组织缺损范围4.0 cm×3.0 cm^10.5 cm×8.0 cm,皮瓣切取范围4.5 cm×3.5 cm^11.0 cm×8.5 cm,观察疗效供区行自体皮移植封闭.术后常规应用石膏托或支具外固定、抗感染、改善微循环等综合治疗与护理.结果:术后,14例皮瓣及皮片完全成活,1例皮瓣远端部分坏死,经换药痊愈.经6~20个月随访,15例患者皮瓣成活良好,踝关节活动自如;皮瓣及足内侧缘的皮肤感觉良好.结论:保留隐神经穿支的隐神经营养血管皮瓣具有操作简单可靠、皮瓣质地较好、解剖位置变异少、早期功能恢复、皮瓣成活率较高等优点;且比传统隐神经营养血管皮瓣,能更好地保留隐神经支配区的感觉功能,值得推广.

Objective:To explore the effect of the saphenous neurovascular flap with the saphenous perforator nerve on repairing soft tissue defects of the ankle.Methods:Fifteen cases of soft tissue defects of the ankle were repaired with a saphenous neurovascular flap with the saphenous perforator nerve in hospital.The soft tissue defect ranged from 4.0 cm×3.0 cm to 10.5 cm×8.0 cm and the flap was cut to a range of 4.5 cm×3.5 cm to 11.0 cm×8.5 cm;the donor site was closed by autologous skin grafting.Postoperative routine application of plaster or brace external fixation,anti-infection,improved microcirculation and other comprehensive treatment and care were given.Results:14 cases had complete survival of skin flap and flap,and 1 had necrosis of distal part of flap,but recovered afterwards.After follow-up visits for 6 to 20 months,the flaps all survived and recovered well in sensory in 15 cases and all the patients can move the ankle joints freely.Conclusion:The saphenous neurotrophic vascular flap the saphenous perforator nerve has numerous advantages of simple and reliable operation,good flap texture,less anatomical position variation,early functional recovery,and higher survival rate of flap.Compared with traditional saphenous neurovascular flap,it is better to preserve the sensory function of the saphenous nerve dominating area.