不同形状蒂部减张瓣在逆行皮神经营养血管皮瓣中的应用

目的：探讨3种不同形状蒂部减张瓣在皮神经营养皮瓣逆行转移术中的应用及其疗效。方法：自2006年1月至2012年1月，皮瓣坏死患者21例，男15例，女6例；年龄14～58岁，平均35岁；应用三角形、椭圆形或圆形蒂部减张皮瓣改善逆行皮神经营养皮瓣转移后的血运，三角形瓣10例，圆形瓣8例，椭圆形瓣3例。手部软组织缺损5例，面积为5．0 cm×2．0 cm～8．0 cm×5．0 cm；足部、踝周及小腿下段软组织缺损16例，面积6．0 cm×4．0 cm～13．0 cm×7．0 cm；均伴有肌腱及骨骼等深部组织外露。采用足背皮神经营养皮瓣5例，腓浅神经营养血管皮瓣4例，腓肠神经营养血管皮瓣4例，隐神经营养血管皮瓣3例，桡神经浅支营养血管皮瓣2例，前臂外侧皮神经营养血管皮瓣3例，均为逆行转移。观察术后皮瓣成活，外观及感觉恢复情况。结果：1例逆行腓肠神经营养皮瓣远端坏死，经换药愈合，其余皮瓣全部成活，供区植皮均I期愈合。术后患者随访3个月～2年，平均7个月，皮瓣质地良好，外形平整美观，恢复痛温觉。结论：蒂部减张皮瓣能改善远端蒂皮神经营养血管皮瓣的血运，促进其成活，并改善修复创面外观。

Application of the tension skin flap with different shapes in the pedicle of the reverse neurocutaneous island flap

Objective: To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. Methods: From January 2006 to January 2012,there were 21 patients in the study (including 15 males and 6 females),and aged from 14 to 58 years old(35 years old on average). Tension skin flaps with different shapes (triangle,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The tension skin flaps in the pedicle were designed triangularly (10 patients),spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm×2.0 cm to 8.0 cm×5.0 cm),and 16 patients with defects in the foot and inferior segment of leg,or around the ankle (the size from 6.0 cm×4.0 cm to 13.0 cm×7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted,including 5 dorsal neurocutaneous flaps of foot,4 superficial peroneal neurocutaneous flaps,4 saphenous neurocutaneous flaps,3 sural neurocutaneous flaps,2 superficial radial neurocutaneous flaps,3 lateral neurocutaneous flaps of forearm. And the survival rate,appearance and sensory recovery of the flaps were analyzed. Results: The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely,and the donor site all healed primarily. The follow-up time was from 3 months to 2 years (averaged 7 months),and all the flaps had recovered pain and warm sensation with perfect appearance. Conclusion: The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap,and can also improve its appearance.