腓肠神经营养血管皮瓣联合封闭式负压引流“三明治法”修复足踝部皮肤缺损

Sural neurouascular flap and VSD"sandwich technique"for renovation of skin defect in malleoli

目的探讨腓肠神经营养血管皮瓣联合封闭式负压引流(vacuum sealing drainge,VSD)“三明治法”修复足踝部开放性皮肤缺损的临床疗效。方法对本院2009年9月至2020年3月接受以“三明治法”,即逆行腓肠神经营养血管皮瓣联合前后2次VSD敷料封闭负压引流术,修复足踝部开放性皮肤缺损并获得随访的13例患者的资料进行回顾性分析。其中男12例,女1例;年龄12~71岁,平均(34.3±2.0)岁;交通事故5例(轮辐伤3例,拖拉伤2例),重物砸伤4例,机器绞伤3例,爆炸伤1例,均出现骨质和(或)肌腱外露;开放性跟腱损伤3例,踝关节开放性骨折5例,足部开放性骨折4例,内踝骨质缺损1例。结果13例皮瓣术后全部成活。术后随访38~99个月,平均(77.2±3.0)个月,创面皮瓣均覆盖良好。按其外形、感觉、运动、疼痛及负重行走等进行下肢功能评价:优,外形美观,感觉功能恢复良好,无疼痛,对患足负重行走无影响;良,外形稍臃肿,能被患者接受,感觉功能部分恢复,无明显疼痛,患足负重行走功能尚可;可,外形臃肿,需二次整形,感觉功能恢复尚可,患处疼痛,对患足负重行走有一定影响;差,外形臃肿,需二次整形,感觉无恢复,患足疼痛,无法负重行走,需二次手术。13例患者中,10例优,皮瓣外观、血运、质地、弹性、色泽均良好;2例良,其中1例二次入院行皮瓣整形术,效果满意;1例可。结论腓肠神经营养血管皮瓣联合VSD“三明治法”治疗足踝部开放性皮肤缺损,通过一期VSD发挥清创、收缩创面作用,二期VSD起到充分引流、固定皮瓣和/或游离皮片、促进皮瓣愈合及血运重建的作用,可以达到较佳治疗效果,是一种安全有效的治疗足踝部开放性皮肤缺损的方法。

Objective To investigate the clinical efficacy of sural neuro-veno-fasciocutaneous flap united vacuum sealing drainge(VSD)"Sandwich method"in repairing open skin defect of foot and ankle.Methods From September 2009 to March 2020,13 patients with open skin defect of foot and ankle were treated with"Sanming therapy",that is,retrograde sural neurovascular flap combined with VSD dressing twice before and after vacuum sealing drainage.There were 12 males and 1 female with an average age of(34.3±2.0)years(ranged 12~71 years);5 cases of traffic accidents(3 cases of spoke injury,2 cases of traction injury),4 cases of heavy object injury,3 cases of mechanical strangulation injury and 1 case of explosion injury;3 cases of open achilles tendon injury,5 cases of ankle joint open fracture,4 cases of foot open fracture and 1 case of medial malleolus bone defect.Results All flaps survived.The patients were followed up for 38~99 months,average(77.2±3.0)months.The flaps were covered well.The lower limb function was evaluated according to the shape,feeling,movement,pain and weight-bearing walking:excellent represents beautiful appearance,good sensory function recovery,no pain,no influence on the load-bearing walking of the affected foot;good is slightly bulky,can be accepted by the patients,partial recovery of sensory function,no obvious pain,the walking function of the affected foot is acceptable;acceptable represent the appearance of bloated,need secondary plastic surgery,the recovery of sensory function was fair,and the affected area was painful,which had a certain impact on the weight-bearing walking of the affected foot;poor was that the appearance was bloated and needed secondary plastic surgery,but the feeling did not recover,the affected foot was painful and could not walk with load,so a second operation was needed.Among the 13 cases,10 cases were excellent,the appearance,blood supply,texture,elasticity and color of the flap were good;2 cases were good,of which 1 case was admitted to hospital for the second time,and the effect was satisfactory;1 case was acceptable.Conclusion Sural neurovascular flap combined with VSD"Sanming therapy"is a safe and effective treatment for open skin defect of foot and ankle.One stage VSD can play the role of debridement and contraction of wound surface,and the second stage VSD can fully drain,fix and/or free skin flap,promote skin flap healing and blood supply reconstruction,which can achieve better therapeutic effect and is a safe and effective treatment for open skin defect of foot and ankle method of loss.