闭式负压引流联合带腓肠神经营养血管皮瓣修复近踝足部肌腱与骨外露创面

目的:评价用闭式负压引流(VSD)技术联合带腓肠神经营养血管皮瓣修复近踝足部肌腱与骨外露创面的实用方法。方法:2006年1月至2009年1月应用VSD技术联合带腓肠神经营养血管皮瓣修复治疗79例近踝足部肌腱与骨外露创面患者,男58例,女21例;年龄7～59岁,平均34岁。其中小腿下1/3及跟腱区17例,外踝及足背外侧区28例,内踝及足内侧区21例,足跟及足底13例。创面Ⅰ期用VSD技术清创培养,Ⅱ期用带腓肠神经营养血管皮瓣修复。结果:皮瓣面积最大18 cm×15 cm,最小6 cm×5 cm。住院时间14～30 d,平均18 d。79例患者随访6～36个月,2例皮瓣大部分坏死,3例皮瓣皮缘坏死,5例皮瓣术后出现静脉回流障碍,其余皮瓣均成活良好,无感染。结论:通过VSD技术可尽快形成一个肉芽组织新鲜清洁的创面;带腓肠神经营养血管皮瓣能为近踝足部肌腱与骨外露创面提供良好的覆盖。二者联合应用创面愈合快,修复后外形好,耐磨擦,大大缩短了患者住院时间。

Analysis of the vacuum sealing drainage technique combined with sural neurovasculr pedicle fascio-cutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons

Objective: To evaluate the practical method of vacuum sealing drainage (VSD) technique combined with sural neurovasculr pedicle fasciocutaneous flap to repair deep wounds in the foot near the ankle joint with exposed bone and tendons. Methods: From January 2006 to January 2009,79 patients with deep wounds in the foot near the ankle joint with exposed bone and tendons were treated by VSD technique combined with sural neurovasculr pedicle fasciocutaneous flap including 58 males and 21 females with an average age of 34 years old ranging from 7 to 59 years. There were 17 cases in low 1/3 part of leg and achilles tendon,28 in lateral malleolus and lateral dorsum of foot,21 in medial malleolus and medial dorsum of foot,13 in heel and pelma. Firstly the wounds were debrided and cultivated by using VSD technique,then the soft tissue defections were repaired with sural neurovasculr pedicle fasciocutaneous flap. Results: The area of flap was from 6 cm×5 cm to 18 cm × 15 cm; All patients stayed in hospital for 14 to 30 days,18 days in average. Living flaps of all patients were followed-up from 6 months to 3 years,the flaps of 2 patients were mostly necrotic,3 were necrotic,5 cases appeared obstacle of venous back streaming. The others survived with no infections. Conclusion: The wound would become fresh and clean as soon as possible with VSD. The sural neurovasculr pedicle fasciocutaneous flap could provide a good covering for the exposed wound. Therefore the wound healed faster with friction resistance and fine appearance. The time of hospitalization were greatly shortened after combined application.