应用4种皮瓣修复小儿足跟部软组织缺损的临床效果

目的 探讨应用4种皮瓣修复小儿足跟部软组织缺损的临床效果.方法 2006年8月～2010年9月采用小腿外侧皮瓣、外踝上动脉皮瓣、股前外侧皮瓣和腓肠神经营养皮瓣修复小儿足跟部软组织缺损33例,年龄3～12岁.缺损面积:4cm×3cm～18cm×11cm;8例伴有跟腱缺损.切取皮瓣面积:5cm×4cm～20cm×13cm;小腿外侧逆行岛状皮瓣10例、股前外侧皮瓣9例、腓肠神经营养皮瓣8例、外踝上动脉皮瓣6例.结果 33例经8～19个月随访,皮瓣外形和质地良好,术后皮瓣全部成活.其中2例股前外侧皮瓣发生静脉危象,经重新吻合静脉后皮瓣成活;3例腓肠神经营养皮瓣发生远端边缘坏死,最大1.5cm×1c

Clinical effect of 4 types of flap in repairing heel soft tissue defect in children

Objective To investigate the clinical results of 4 types of flaps in repairing heel soft tissue defect in children.Methods From Aug.2006 to Sep.2010,33 children aging 3-12 with heel soft tissue defect were repaired with lateral lower leg flap,lateral malleolar artery flap,anterolateral thigh flap and sural nerve flap.The defects area ranged from 18 cm×11cm to 4 cm×3cm and eight cases were found with Achilles tendon defect.The flaps size ranged from 20 cm×13cm to 5 cm×4cm and lateral lower leg island flap was applied in 10 cases,anterolateral thigh flap in 9 cases,sural nerve flap in 8 cases,lateral artery flap in 6 cases.Results All flaps in the 33 cases were survived.However,venous crisis occurred in anterolateral thigh flap in 2 patients,who were survived after venous re-anastomosis.Distal edge necrosis（maximum 1.5cm×1cm） occurred in sural nerve flaps in 3 patients,who were healed after wound dressing.After 8 to 19 months follow-up,good flap shape and texture were achieved.Among 8 cases of Achilles tendon defects with anterolateral thigh flap and iliotibial tract reconstruction,flexor ankle function was recovered in 5 cases,weakened ankle flexor muscle and remarkable limp were observed in 3 cases.Conclusion Applying lateral lower leg flap,lateral malleolar artery flap and sural nerve flap is a good method to repair small-size heel soft tissue defect in children,with advantages of simple procedure,mini-invasiveness,good flap shape and texture.Meanwhile,applying anterolateral thigh flap is an effective way to repair large-size heel soft tissue defect combined wth achilles tendon defect in children.