改良与传统逆行腓肠神经营养血管筋膜皮瓣修复足踝部软组织缺损的疗效对比

Comparison of the Efficacy of Modified and Traditional Retrograde Sural Neurofasciocutaneous Flap for Repairing Foot and Ankle Soft Tissue Defects

目的:探究比较改良与传统逆行腓肠神经营养血管筋膜皮瓣修复足踝部软组织缺损的疗效。方法:回顾性选取2019年1月-2022年9月于笔者医院接受逆行腓肠神经营养血管筋膜皮瓣修复的足踝部软组织缺损患者80例为研究对象,根据术中是否保留腓肠神经将患者分为传统组(切断腓肠神经并携带其于皮瓣内,n=34)和改良组(保留腓肠神经及其外膜于供区或进一步分离腓肠神经外膜,n=46)。统计比较两组患者手术相关指标、足踝功能(美国矫形外科足踝协会Maryland足功能评分系统)、感觉功能(英国医学研究会感觉功能评定标准)及患者的美观满意度。结果:两组患者皮瓣成活率均为100.00%,改良组手术时间长于传统组,两点辨别觉(2-point discrimination,2PD)差值小于传统组(P<0.05)。术后6个月,两组患者Maryland足功能评分、修复美观度满意率比较差异无统计学意义(P>0.05);改良组感觉功能分级S3~S4级比例高于传统组(P<0.05)。结论:逆行腓肠神经营养血管筋膜皮瓣修复足踝部软组织缺损疗效好,美观度较高。术中保留腓肠神经有利于术后神经支配区感觉恢复,但手术时间较长,临床应对患者情况进行综合评估,选择合适的手术方式。

Objective To compare the efficacy of modified and traditional retrograde sural neurotrophic vascular fasciocutaneous flap in repairing soft tissue defects of foot and ankle.Methods A total of 80 patients with foot and ankle soft tissue defects who underwent retrograde sural neurofasciocutaneous flap repair in the author's hospital between January 2019 and September 2022 were reviewed.According to the treatment of sural nerve during operation,the patients were divided into traditional group(flaps carrying cutting-off sural nerve,n=34)and modified group(reserving sural nerve and its outer membrane in the donor area or further separating the sural epineurium,n=46).The surgery-related indicators,foot and ankle function(American Orthopaedic Foot and Ankle Society Maryland Foot function scoring system),sensory function(British Medical Research Council sensory function evaluation criteria)and aesthetic satisfaction of patients were statistically compared between the two groups.Results All flaps in the two groups survived.Operation time of modified group was longer than that of traditional group,and 2-point discrimination(2PD)was smaller than that of traditional group(P<0.05).There was no significant difference in Maryland foot function score or satisfaction with aesthetics after repair between the two groups at 6 months after operation(P>0.05).The proportion of grade S3-S4 sensory function in modified group was higher than that in traditional group(P<0.05).Conclusion Applying retrograde sural neurofasciocutaneous flaps to repair foot and ankle soft tissue defects can achieve good repair effect and high aesthetics.Preserving the sural nerve during operation is beneficial for postoperative sensory recovery in the innervated area,but the operation time is longer.In clinical practice,the patient's condition should be evaluated comprehensively to choose an appropriate operation method.