腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损

目的 探讨腓动脉穿支腓肠神经营养血管皮瓣逆行转移修复足踝部软组织缺损的临床治疗效果。 方法　2011年11月~2014年3月，运用以腓动脉穿支腓肠神经营养血管皮瓣逆行转移修复足踝部软组织缺损31例。软组织缺损部位：踝前部12例，外踝部10例，足跟部9例。软组织缺损面积 1.0 cm×0.8 cm～18.0 cm×10.0 cm，切取皮瓣面积 2.5 cm×7.0 cm~21.0 cm×12.0 cm，供区直接闭合或游离皮片覆盖。 结果 术后31例皮瓣29例全部成活，2例皮瓣远端局部表层皮肤坏死，经换药治疗后愈合。平均随访19个月，所有患者伤口愈合良好，皮瓣负重区无破溃，皮瓣色泽、质地良好。恢复穿鞋、行走功能。 结论　该皮瓣切取简单，血供可靠，不牺牲主要血管，修复效果满意。腓动脉穿支腓肠神经营养血管皮瓣是修复足踝部软组织缺损的理想选择。

Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for foot and ankle reconstruction

Objective　To investigate the clinical effects of peroneal perforator-plus pedicled sural neurofasciocutaneous flapfor retrograde repair of ankle and foot soft-tissue defects.　Methods　31 patients with soft-tissue defects in ankle and foot were treated by peroneal perforator-plus pedicled sural neurofasciocutaneous flaps from November 2011 to March 2014. The defects were in anterior ankle areas (12 cases), lateral malleolus(10 cases) and heel(9 cases). The wound area was 4.5 cm×4.0 cm～18.0 cm×10.0 cm.The flap area was 5.0 cm×4.5 cm～21.0 cm×12.0 cm. The donor areas are closed directly or in split-thickness skin grafts.　Results　29 of total 31 cases healed by first intention, and 2 cases with some distal superficial skin necrosis healed after dressing change. After an averagefollow-up of 19 months, all wounds healed well without any recurrence, and there was no ulceration in the weight-bearing area of the flap. The color and texture of the flaps were good and the shape of the pedicle was satisfactory. All patients could wear shoes and ambulate well.　Conclusion　The blood supply of this flap is reliable without sacrifice of major arteries，and the flap survival rate is not reduced. This flap is an ideal choice for repair of tissue defectsover foot and ankle.