V-Y推进皮瓣治疗儿童足部轮辐伤八例

V-Y advancement flap for treatment of children with foot spoke injury:Report of 8 cases

目的探讨采用V-Y推进皮瓣在儿童足部轮辐伤的治疗效果。方法回顾性分析2019年6月至2021年10月华北医疗健康集团邢台总医院骨三科收治的8例足部轮辐伤患者临床资料,男6例,女2例,年龄2.5~5.0岁,平均3.5岁,跟腱周围软组织缺损面积2.0 cm×3.0 cm~2.5 cm×4.0 cm,皮瓣面积2.5 cm×3.5 cm~3.0 cm×4.5 cm。所有患者入院后行急诊清创加V-Y推进皮瓣修复,供区直接缝合。术后观察皮瓣血运、成活及皮瓣供区愈合情况,定期门诊复查足跟外形与患肢功能恢复情况。结果8例皮瓣全部成活,创面一期愈合。患者术后随访6~12个月,平均8个月。皮瓣修复处质地、色泽良好,皮瓣蒂部与供区、受区外形满意,术后足部穿鞋不受影响,踝关节功能活动可,平均背伸25.8°(20°~30°),跖屈32.5°(25°~40°),足部感觉及行走功能接近正常,采用美国足踝外科协会(AOFAS)足功能评分为(91.7±6.4)分。优5例,良3例。结论应用V-Y推进皮瓣修复儿童足部轮辐伤后软组织缺损的术式简单,修复后皮瓣外观满意,肢体功能恢复好,是处理跟腱区较小面积缺损的一种理想方法。

Objective To investigate the effect of V-Y advancement flap in the treatment of foot spoke injury in children.Methods Clinical data of 8 patients,including 6 males and 2 females aged 2.5-5.0(mean,3.5)years old with foot spoke injury admitted to the Third Ward of Department of Orthopaedic Surgery,Xingtai General Hospital of North China Medical and Health Group from June 2019 to October 2021,were analysed retrospectively.Soft tissue defect around achilles tendon was 2.0 cm×3.0 cm-2.5 cm×4.0 cm.The size of the flap was 2.5 cm×3.5 cm-3.0 cm×4.5 cm.All patients underwent emergency debridement followed by V-Y advancement flap repair,and direct suture of the skin and tissues at donor site.The blood supply,survival and healing of flap of donor site were observed after operation.The shape of the heel and the functional recovery of the affected limb were examined on regular basis at the outpatient clinic.Results All 8 flaps survived and the wounds had primary healing.The patients entered the follow-up for 6-12 months,with an average of 8 months.The texture and colour of the flap recipient site were good.The shape of the flap pedicle,the donor site and recipient site were satisfactory.The shoes wearing of the affected foot were not affected after surgery.The ankle function was good.The average extension was 25.8°(20°-30°),plantar flexion 32.5°(25°-40°),and the foot sensation and motion were close to normal.The average foot function score on American Association on Foot and Ankle Surgery(AOFAS)was 91.7±6.4.Five cases were excellent and 3 were good.Conclusion The V-Y advancement flap demonstrates an ideal alternative method for treatment of small area of soft tissue defect around Achilles tendon,due to the simple operation,satisfactory shape of flap after repair,and favorable limb function.