封闭负压引流结合穿支蒂皮神经营养血管皮瓣治疗足踝部创面

目的探讨封闭负压引流技术结合3种小腿穿支蒂皮神经营养血管皮瓣治疗足踝部皮肤软组织缺损的临床效果。方法回顾性分析自2010-08—2013-06诊治的38例足踝部皮肤软组织缺损,创面彻底清创并应用封闭负压引流5~7 d后根据创面情况选择皮瓣修复,17例应用腓动脉穿支蒂腓肠神经营养血管皮瓣修复,8例应用外踝上穿支蒂腓浅神经营养血管皮瓣修复,13例应用胫后动脉穿支蒂隐神经营养血管皮瓣修复。结果术后皮瓣全部成活。随访5~12个月,无感染、骨坏死和慢性骨髓炎等并发症发生;皮瓣质地柔软,有弹性,供区愈合良好,足踝外形与功能恢复满意。结论应用封闭负压引流技术处理足踝部皮肤软组织缺损创面后,合理个体化选择小腿穿支蒂皮神经营养血管皮瓣修复,可减少感染机会及肉芽瘢痕,利于功能恢复。

Closed negative pressure drainage combined with perforator neurocutaneons flaps for reconstruction of defects at ankles and feet

Objective To evaluate the therapeutic effect of closed negative pressure drainage combined with perforator neuroeutaneous flaps for reconstruction of defects at ankles and feet. Methods From Aug. 2010 to Jun. 2013,38 cases of defects caused by high energy at ankles and feet were retrospectively studied. After treated with closed negative pressure drainage for 5 to 7 days, the wound infection was effectively controlled and the growth of wound granulation tissue was good. Thirty eight eases with 38 defects were treated by 17 sural neuroeutaneous flaps based on the peroneal perforator, 8 superficial peroneal ones on the lateral superamalleolar perforating artery and 13 saphenous neurocutaneous flaps on the posterior tibial perforator. Results All flaps survived successfully without necrosis. The follow-up time was 5-12 months, and then the clinical effects were observed with a result of good recovery and no ulceration for the flaps. To varying degree, sense of pain and deep touch of all flaps recovered. The walking and shoe wearing function of all patients recovered. Conclusion The three kinds of perforator neurecutaneous flaps have reliable blood supply with a relatively large size. They can be chosen and designed individually for all kinds of defects at ankle and foot. There are many advantages for closed negative pressure drainage combined with perforator neurocutaneous flaps, such as less secondary necrosis and lower risk of chronic infection. Moreover, the reduction of granulation and scar tissues benefits functional rehabilitation.