负压封闭引流联合股前外侧穿支皮瓣修复足部软组织缺损创面

Application of Vacuum Sealing Drainage Combined with Anterolateral Thigh Perforator Flap in the Repair of Soft Tissue Defects of the Foot

目的:探究负压封闭引流(Vacuum sealing drainage,VSD)联合股前外侧穿支皮瓣在足部软组织缺损创面修复中的临床效果。方法:回顾性分析2017年6月-2021年6月笔者医院修复足部软组织缺损创面的75例患者,根据治疗方式分为联合组40例患者VSD联合股前外侧穿支皮瓣处理创面,对照组(35例)则选用传统清创探查术联合股前外侧穿支皮瓣移植方案治疗。对两组皮瓣成活情况、外观及皮瓣厚薄与患者感觉功能及足部功能恢复情况进行评估。结果:术后随访3个月,联合组皮瓣成活率(95.00%)、外观恢复良好(97.50%)均高于对照组(71.43%、80.00%),差异有统计学意义(P<0.05)。联合组皮瓣边缘和远端坏死、不适感发生率均低于对照组,差异有统计学意义(P<0.05)。联合组患者总满意度为92.50%高于对照组的62.86%,差异有统计学意义(P<0.05)。联合组保护性感觉功能(70.00%)显著高于对照组(40.00%),且联合组美国足与踝关节协会踝-后足评分系统(American orthopedic foot and ankle society,AOFAS)评分高于对照组,差异有统计学意义(P<0.05)。结论:选择VSD联合股前外侧穿支皮瓣修复足部软组织缺损,可有效控制创面软组织感染,神经功能恢复良好,是修复足部软组织缺损的理想方法之一。

Objective To explore the clinical effect of vacuum sealing drainage(VSD)combined with anterolateral thigh perforator flap in the repair of soft tissue defects of the foot.Methods A retrospective analysis was performed on the 75 patients undergoing repair of soft tissue defects of the foot in the hospital between June 2017 and June 2021.According to different treatment methods,they were divided into the combination group(40 cases,VSD combined with anterolateral thigh perforator flap)and the control group(35 cases,traditional debridement combined with anterolateral thigh perforator flap).The survival,appearance and thickness of flaps,and recovery of sensory function foot function in both groups were evaluated.Results According to the 3-month follow-up after surgery,the skin flap survival rate(95.00%)and good appearance recovery(97.50%)in the combination group were higher than those in the control group(71.43%,80.00%),and the differences were statistically significant(P<0.05).The incidence of necrosis and discomfort at the edge and distal end of the flap in the combination group was lower than that in the control group(P<0.05).The total satisfaction of patients in the combination group was 92.50%higher than that in the control group(62.86%,P<0.05).The protective sensory function(70.00%)of the combination group was significantly higher than that of the control group(40.00%,P<0.05).And the AOFAS score of the combination group was higher than that of the control group(P<0.05).Conclusion The application of VSD combined with anterolateral thigh perforator flap in the repair of soft tissue defects of the foot can effectively control infection of wound soft tissues,with good recovery of nerve function.It is one of the ideal methods to repair the soft tissue defects of the foot.