足部大面积皮肤软组织缺损的皮瓣修复临床分析

目的:比较足部大面积皮肤软组织缺损应用不同类型皮瓣(小腿主干血管逆行皮瓣、皮神经营养血管逆行皮瓣和游离皮瓣)修复的临床效果。方法:57例足部大面积皮肤软组织缺损的患者清创后,应用不同类型的皮瓣进行修复,并比较其成活面积、观察其疗效。其中,小腿主干血管逆行皮瓣14例,面积:7～9cm×11～20cm,平均:8cm×16cm,采用胫后动脉逆行皮瓣3例,腓动脉逆行皮瓣11例;皮神经营养血管逆行皮瓣26例,面积:7～9cm×9～15cm,平均:8cm×11cm,采用腓肠神经营养血管逆行岛状皮瓣23例,隐神经营养血管逆行岛状皮瓣3例;游离皮瓣17例,面积:9.5～15cm×12～28cm,平均:12cm×25cm,采用股前外侧皮瓣13例,隐动脉皮瓣3例,胸背动脉皮瓣1例。结果:57例皮瓣中,完全坏死2例,部分坏死7例,其余全部成活。坏死者全部涉及前足皮肤缺损,其中,主干血管逆行皮瓣完全坏死1例,部分坏死2例;皮神经营养血管逆行皮瓣远端部分坏死5例;游离皮瓣完全坏死1例。统计学分析:皮瓣面积按类型比较(ANOVA),P=0.000,差异有非常显著性意义;皮瓣成活率按类型比较(Kruskal-Wallis Test),P=0.455,差异无显著性意义。经3～18个月随访,所有成活皮瓣血运、外形、质地、功能均满意。结论:大部分足部大面积皮肤软组织缺损可选用皮神经营养血管逆行皮瓣进行修复,但如果涉及前足,特别是缺损较大时,选择游离皮瓣更为适宜。

Clinical analysis of repair of large skin defects in feet with flaps

Objective To analyze the clinical outcomes of three different type flaps （retrogressive flaps based on trunk vessel in leg, retrogressive cutaneous neurovascular island flaps, and free flaps） for repair of large skin defects in feet. Methods After thorough debridement,57 cases of large skin defects in feet were repaired by three different type flaps, including 14 cases of retrogressive flaps based on trunk vessel in leg with the average survive size of 8cm×16cm （7- 9cm×11-20cm）： 3 cases of retrogressive flaps based on posterior tibial artery, 11 cases of retrogressive flaps based on peroneal artery; 26 cases of retrogressive cutaneous neurovascular island flaps with the average survive size of 8cm× 11cm （7-9cm×9-15cm）： 23 cases of distal pedicle sural neurovascular island flaps and 3 cases of distal pedicle saphenous nerve neurovascular island flaps; 17 cases of free skin flaps with the average survive size of 12cm×25cm （9.5-15cm×12-28cm）： 13 cases of lateral thigh flaps,3 cases of arteria saphena flaps,and 1 case of thoracodorsal artery flap; and the clinical outcomes were observed. Results After 3 to 18 months follow-up, the flaps survived completely reveal sufficient blood supply, good shape, perfect texture and satisfactory outcome excluding 2 cases of complete necrosis （1 case of free skin flap and the other case of retrogressive flaps based on trunk vessel in leg） and 7 cases of distal marginal part necrosis （5 cases of distal pedicle nerve neurovascular island flaps and 2 cases of retrogressive flaps based on trunk vessel in leg）. According to flap types, significant difference was between survive size （ANOVA, P=0.000）,while no difference between survive ratio （Kruskal-Wallis Test, P=0.455）. Conclusion Most skin defects of feet can be effectively repaired by distal pedicle cutaneous neurovascular island flaps, while if the defects encroached in forefeet especially when the defects size are comparatively large, free flaps should be strongly recommended.