穿支螺旋桨皮瓣和腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床价值对比

目的分析并比较穿支螺旋桨皮瓣和腓肠神经营养血管皮瓣修复足踝部软组织缺损的临床价值。方法选取2015年7月至2018年5月本院收治的足踝部软组织缺损患者57例为研究对象,根据创面局部情况及创面位置选择不同皮瓣修复,分为穿支螺旋桨皮瓣组(n=27)和腓肠神经营养血管皮瓣组(n=30)。比较两组术后皮瓣存活情况,随访6个月,采用改良Weber标准评价患者踝关节功能,统计两组患者术后温度觉、触觉,供区瘢痕挛缩及满意度。结果穿支螺旋桨皮瓣组手术时间短于神经营养血管皮瓣组,术后皮瓣坏死发生率低于神经营养血管皮瓣组,但差异均无统计学意义(P>0.05);术后6个月,两组在疼痛、步态、日常活动、踝活动范围及距下关节活动范围方面评分差异无统计学意义(P>0.05);在肿胀方面,穿支螺旋桨皮瓣组评分低于神经营养血管皮瓣组,差异有统计学意义(P<0.05);术后6个月,两组皮瓣温度觉、触觉及瘢痕挛缩比较,差异无统计学意义(P>0.05);术后两组满意度比较,差异无统计学意义(P>0.05)。结论穿支螺旋桨皮瓣和腓肠神经营养血管皮瓣均可有效修复足踝部软组织缺损,但穿支螺旋桨皮瓣修复在外观恢复方面具有一定优势。

Clinical value comparison of perforator pedicle propeller flap and sural neurocutaneous vascular flap in repairing soft tissue defects of ankle

Objective To analyze and compare the clinical value of perforator pedicle propeller flap and sural neurocutaneous vascular flap in repairing soft tissue defects of ankle. Methods A total of 57 patients with soft tissue defects of ankle in the hospital from July 2015 to May 2018 were enrolled. According to the local condition and the location of the wound, different flaps repaired were selected. They were divided into perforator pedicle propeller flap group (n=27) and sural neurocutaneous vascular flap group (n=30). The survival conditions of the flaps after surgery were compared between the two groups. After 6 months of follow-up, the improved Weber criteria were performed to evaluate the ankle joint function. The postoperative temperature perception, tactile sensation, scar contracture in donor site and satisfaction of the two group were statistically analyzed. Results The operation time in perforator pedicle propeller flap group was shorter than that in sural neurocutaneous vascular flap group, and the incidence of postoperative flap necrosis was lower than that in sural neurocutaneous vascular flap group (P>0.05). After 6 months of surgery, there was no significant difference in the scores of pain, gait, daily activity, activity range of ankle and subtalar joint between the two groups (P>0.05). In the aspect of swelling, the score of perforator pedicle propeller flap group was lower than that of sural neurocutaneous vascular flap group (P<0.05). There was no significant difference in temperature perception, tactile sensation or scar contracture between the two groups at 6 months after surgery (P>0.05). There was no significant difference in the satisfaction between the two groups after surgery (P>0.05). Conclusion Both perforator pedicle propeller flap and sural neurocutaneous vascular flap can effectively repair the soft tissue defects of the ankle. However, the former has certain advantages in appearance recovery.