远端蒂腓肠神经营养血管皮瓣近端位置与部分坏死的关系

目的 探讨远端蒂腓肠神经营养血管皮瓣的近端位置对皮瓣部分坏死的影响.方法 回顾性分析2001年4月至2009年5月应用远端蒂腓肠神经营养血管皮瓣转移修复小腿下段及足踝部创面的病例资料,共153位患者157例皮瓣.将小腿后面从外踝尖至腘窝横纹等分为9个区,从下至上依次为第1至第9区.皮瓣分为成活组(包括完全成活、远端表皮坏死和伤口裂开的皮瓣)和部分坏死组;根据皮瓣近端位置,将皮瓣分为近端不超过第6区(A组)、位于第7区(B组)、第8区(C组)和第9区即小腿上1/9区段(D组)4个组.皮瓣采用顺逆结合法切取.结果 皮瓣完全成活125例;远端表皮坏死8例,远端伤口裂开6例;远端部分坏死18例(11.5%).A、B、C和D组皮瓣部分坏死率分别为0(0/19)、2.3%(1/44)、11.3%(7/62)和31.3%(10/32),A组与B组、B组与C组比较,皮瓣部分坏死率的差异均无统计学意义(P＞0.05);皮瓣部分坏死率:D组高于C组(P=0.012)、近端位于小腿下7/9区域的皮瓣(1.6%,1/63)低于小腿上2/9区域的皮瓣(18.1%,17/94),差异均有统计学意义(P=0.001).结论 远端蒂腓肠神经营养血管皮瓣的近端不超过小腿下7/9与上2/9交界线时,皮瓣成活可靠;皮瓣近端位于小腿上1/9区段时,皮瓣部分坏死的可能性明显增大.

Relationship between proximal-tip location and partial necrosis in distally based sural neurofasciocutaneous flap: an analysis of 157 flaps

Objective To explore the influence of proximal-tip location on partial necrosis in distally based sural neurofasciocutaneous flap. Methods From April 2001 to May 2009,157 distally based sural neurofasciocutaneous flaps were conducted to repair the soft tissue defect in distal region of lower leg, ankle and feet in 153 patients. Date of the flaps and the patients were retrospectively analyzed.From the tip of lateral malleolus to the popliteal crease, posterior aspect of the lower leg was equally divided into 9 regions that were 1st to 9th region from inferiorly to superiorly, respectively. The flaps were divided into 2 groups: survial group(including unevenffully survived flaps, flaps with distally epidermical necrosis and with wound dehiscence)and partial necrosis group. Based on the location of the proximal tip of flaps,the flaps were stratified into 4 groups:flaps with the proximal tip locating in the 6th or lower region(group A), the 7th region(group B),the 8th region(group C)and the 9th region(group D). Harvesting the flaps started from exploring the perforator of peroneal vessel in the adipofascial pedicle , then the flaps were elevated retrogradely. Results Of the 157 flaps, 125 survived uneventfully, 8 showed distal epidermal necrosis,wound dehiscence occurred in 6 flaps, 18 flaps(11.5%)showed distal partial necrosis. Partial necrosis occurred in zero of 19 flaps in group A(0), 1 of 44 flaps in group B(2.3%), 7 of 62 flaps in group C(11.3%)and 10 of 32 flaps in group D(31.3%). The differences in partial necrosis rate between group A and group B 、group B and group C,were not statistically significant (P ＞0. 05). Partial necrosis rate was higher in group D than in group C(P =0. 012),it was lower in group A + group B(1.6%)than in group C + group D (18.1%)(P = 0. 001). Conclusions Distally based sural neurofasciocutaneous flap can survive reliably when the proxiamal tip of flap is not beyond the junction between lower 7/9 and upper 2/9 of the lower leg, whereas probability of partial necrosis occuring in the flap increase significantly when the proximal tip of flap locates in upper 1/9 of the lower leg.