腓肠神经延迟皮瓣修复足部软组织缺损的临床效果

Clinical effect of delayed sural neurocutaneous flap for reconstruction of soft-tissue defect of the foot

目的观察腓肠神经延迟皮瓣修复足部软组织缺损的临床应用效果。方法自2008年1月至2018年1月,甘肃省兰州市兰州手足外科医院骨科腓肠神经延迟皮瓣修复足部软组织缺损36例,男22,女14;年龄26~82岁,平均(50.5±20.4)岁;软组织缺损范围(6 cm×4.5 cm)~(22 cm×15 cm);皮瓣延迟时间8~12 d,平均(9.7±2.4)d。皮瓣延迟期间创面暂时应用负压封闭引流覆盖。延迟皮瓣修复受区创面后,供区用中厚游离植皮修复。结果延迟皮瓣全部成活,2例皮瓣发生小的皮缘裂开,术后2周自然愈合。1例供区植皮发生小片坏死,经游离植皮愈合。术后随访1.5~4.5年,平均(3.5±1.4)年,所有软组织缺损修复成功,皮瓣颜色、质地与外形较好,本组取得了较满意的临床效果。结论腓肠神经延迟皮瓣修复足部软组织缺损安全、可靠,很适用于伴高风险患者或皮瓣切取较大者。

Objective To report the clinical effect of delayed sural neurocutaneous flap for the reconstruction of soft-tissue defect of the foot.Methods From January 2008 to January 2018,36 patients(22 men and 12 women)with soft-tissue defect in the foot underwent reconstruction with a delayed sural neurocutaneous flap.They ranged in age from 26 to 82 years[mean of(50.5±20.4)years].Soft-tissue defect size in the foot ranged from 16 cm×4.5 cm to 22 cm×15 cm.The delay period ranged from 8 to 12 days[mean of(9.7±2.4)days].Temporary wound coverage was achieved by vacuum sealing drainage during the delay period.After the delayed flap was used to repair the wound of the recipient area,donor site was covered using split-thickness free skin grafts.Results All the delayed flaps had survived completely.Two flaps developed small wound dehiscence,which spontaneously healed 2 weeks after surgery.In one case,the skin grafts in the donor area had small necrosis and were healed with free skin grafts.Follow-up period ranged from 1.5 to 4.5 years[mean of(3.5±1.4)years]postoperatively.All soft-tissue defects were successfully repaired with good color,texture,and contour of the flaps.Satisfactory clinical results were obtained in this series.Conclusion Delayed sural neurocutaneous flap for reconstruction of soft-tissue defect of the foot is safe,reliable,and particularly suitable for high-risk patients or harvesting a large flap.