扩大小隐静脉-腓肠神经营养血管皮瓣的临床应用

Clinical application of enlarged flap supplied by vascular axis of small sapheonus vein and sural nerve

总结扩大小隐静脉 -腓肠神经营养血管皮瓣面积的方法 ,探讨该皮瓣血供特点及临床应用。对 17例大面积皮瓣 (16cm× 10 cm～ 2 5 cm× 16 cm)的病例资料进行回顾性分析。该 17例分别为小腿骨折术后骨外露并感染及骨不连 ,胫前皮肤溃疡长期不愈 ,踝关节开放骨折脱位并肌腱外露 ,足跟皮肤缺损跟腱断裂 ,足背皮肤缺损肌腱骨外露的病例。均采用逆行小隐静脉 -腓肠神经营养血管皮瓣修复。经随访 6～ 30个月 ,除 1例远端边缘少许表皮坏死外 ,其余皮瓣全部成活 ,无感染复发 ;骨不连愈合 ;外观恢复满意。分析认为 ,扩大面积的皮瓣血供可靠 ,不伤及重要血管 ,是修复小腿及足踝部皮肤软组织缺损的理想方法 。

This paper summarized the methods of enlarged flap supplied by the vascular axis of the small saphenous vein and sural nerve and studied its clinical application and blood supply. A retrospective study was made on 17 cases of leg fractures with skin defect and infection,chronic ulcer or soft tissue defect in legs,heel skin defect with severed Achillis tendon, ankle opening fracture and dislocation and skin defect of foot dorsum with exposed tendons; all of them were repaired with above flaps measured 16 cm×10 cm to 25 cm×16 cm. After a follow up of 6 to 30 months, all the flaps survived except 1 case with small necrosis at the distal edge. Nonunion was healed and no ulcer or infection reoccurred. The appearance of the flaps were satisfactory. The enlarged flap with reliable blood supply does not impair the main vessels of the leg. Our method is an ideal method for repairing the soft tissue defect in leg, ankle and foot, especially when accompanied with the main vessel impairment.