邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损

目的探讨足跟部皮肤缺损皮瓣修复的优化选择及临床效果. 方法 2000年2月～2004年4月,应用4种邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损30例,其中男19例,女11例,年龄8～65岁.致伤原因:车轮绞伤19例,重物压伤5例,电锯伤3例,骨髓炎2例,足跟部鳞状细胞癌1例.皮肤缺损6.0 cm×5.5 cm～16.5 cm×11.0 cm者14例,均合并足后跟或足底皮肤缺损,采用腓肠神经营养血管远端蒂皮瓣及隐神经营养血管远端蒂皮瓣修复,皮瓣切取范围6.0 cm×5.0 cm～18.0 cm×12.0 cm;皮肤缺损2.5 cm×2.0 cm～5.5 cm×4.5 cm者16例,采用足外侧皮瓣及足底内侧皮瓣修复,皮瓣切取范围4.0 cm×3.0 cm～8.0 cm×7.0 cm.供区采用全厚或中厚皮片移植覆盖. 结果术后皮瓣均成活.获随访6～12个月,皮瓣外观良好,无破溃,2例出现胼胝.皮瓣痛觉或触觉部分或完全恢复,两点辨别觉恢复至1.0～3.2 cm.供区外观恢复良好. 结论采用邻近非主干血管蒂皮瓣移位修复足跟部皮肤缺损,具有切取简便、损伤少、不影响患肢血供、可选择性高和可操作性强等优点,是足跟皮肤缺损修复的一种较好选择.

THE EFFECT OF TRANSFERRING ADJACENT NON-MAIN VESSEL PEDICLE FLAP ON REPAIRING THE HEEL SKIN DEFECT

OBJECTIVE: To explore the effect of transferring adjacent non-main vessel pedicle flap on repairing the heel skin defect. METHODS: From February 2000 to April 2004, 4 kinds of flaps with non-main vessel pedicle were used to repair 30 cases of heel skin defect. Of the 30 patients, 19 were male and 11 were female, whose ages ranged from 8 to 65. Among them, 19 cases were crush injury, 5 cases were press injury, 3 cases were electric saw injury, 2 cases were osteomyelitis, and 1 case was squamous cell carcinoma. Fourteen cases were with defect area ranged from 6.0 cm x 5.5 cm to 16.5 cm x 11.0 cm. All the 14 cases were repaired with distant pedicled sural vascular flap of nutrient vessels and saphenous vascular flap of nutrient vessels. The sizes of the dissected flap ranged from 6.0 cm x 5.0 cm to 18.0 cm x 12.0 cm. And the other 16 cases with defect area ranged from 2.5 cm x 2.0 cm to 5.5 cm x 4.5 cm were repaired with foot lateral flap and foot base medial flap. The sizes of the dissected flap ranged from 4.0 cm x 3.0 cm to 8.0 cm x 7.0 cm. RESULTS: All cases were followed up for 6 to 12 months. The flaps all survived with satisfactory appearance and no ulceration. Callus appeared in 2 cases. The sense of pain and touch was partly or completely restored. The two-point discrimination sense recovered to 1.0-3.2 cm. CONCLUSION: As it is easily accessible, highly flexible and causes little damage to blood circulation, transferring adjacent non-main vessel pedicle flap, is effective in repairing foot heel skin defect.