皮神经营养血管蒂皮瓣修复小腿及足部软组缺损

目的探讨和总结下肢皮神经营养血管蒂皮瓣在修复下肢软组织缺损创面中的临床应用效果。方法采用下肢皮神经营养血管蒂皮瓣修复下肢软组织缺损34例患者（35例皮瓣）,其中腓肠神经营养血管蒂皮瓣17例,腓肠外侧皮神经营养血管蒂皮瓣5例,腓浅神经营养血管蒂皮瓣3例,小腿内侧隐神经营养血管蒂皮瓣7例,足背内侧隐神经终末支营养血管蒂皮瓣3例。结果术后有2例皮瓣出现远端部分小面积坏死（分别为1.0cm×0.5cm,0.8cm×0.6cm）,其余皮瓣全部成活,在3个月~2年的随访中,皮瓣质地良好,下肢行走功能恢复良好,但皮瓣的感觉功能重建效果欠佳。结论下肢皮神经营养血管蒂皮瓣切取方便,皮瓣成活率较高,非常适用于肢体远端,尤其是下肢皮肤软组织缺损的修复,具有较高的临床使用价值。

Clinical application of neurocutaneous flap in repair of the soft tissue defects in the lower leg and foot

Objective To explore and summarize the clinical effect of the neurocutaneous flap in repairing soft tissue defects in lower limb. Methods From August 2007 to December 2010,thirty-four patients with the soft tissue defects in the lower limb were treated with the neurocutaneous flaps. Twonty-nine cases were male,and 5 cases were female. Thirty-five flaps were implemented： sural neurocutaneous flap in 17 cases,lateral sural neurocutaneous flap in 5 cases,superficial peroneal neurocutaneous flap in 3 cases,medial lower leg saphenous neurocutaneous flap in 7 cases,terminal branch of the saphenous nervous flap in 3 cases. Results Small area of necrosis was found in two cases,and the remaining flaps survived wholly. The follow-up for 3months to 2 years revealed that the all the flaps had good texture,good walking functional recovery,but sensory recovery of the flap was not so satisfied.Conclusion With high survival rate and easy surgical procedure,the neurocutaneous vascular flap is of great clinical value in the reparation of limb soft tissue defects,especially in the lower extremity.