显微外科修复足跟部软组织缺损的临床观察

目的：探讨足跟部皮肤软组织缺损修复方法及其临床效果.方法：自1998年6月至2009年6月,收治42例足跟部皮肤及软组织缺损患者,其中男23例,女19例;年龄18～65岁,平均37岁.皮肤缺损范围3 cm×2 cm～18 cm×16 cm.伤后至手术时间8h～10年.足底内侧皮辫13例,腓肠神经小隐静脉营养血管蒂皮瓣18例,隐神经大隐静脉营养血管蒂皮瓣11例.观察术后皮瓣外观、血运、质地、弹性及皮肤两点辨别觉评价术后疗效.结果：术后皮瓣全部成活,其中2例皮瓣远端部分表皮坏死,经换药切痂后用中厚皮片植皮愈合.3例术前有严重深部感染术后残留窦道,经5～12个月换药后窦道痊愈.所有患者获得随访,时间8个月～6年.术后皮瓣外形满意,患肢正常步态行走,皮瓣耐磨,无溃疡发生,有痛觉,两点辨别觉为4～12 mm.结论：足跟部软组织缺损小于8 cm×6 cm选用足底内侧皮瓣修复,手术简单,疗效显著.足跟部缺损面积大于8 cm×6 cm选用皮神经营养血管皮瓣,该类皮瓣具有血供可靠、不牺牲主要动脉、存活率高等优点.

Clinical observation of microsurgial repairing for the treatment of soft tissue defection of heel

Objective: To summarize the clinical effects of the repairing methods for skin and soft tissue defection of heel.Methods: From June 1998 to June 2009,42 patients with skin and soft tissue defection of heel underwent the repairing treatment,including 23 males and 19 females,with an average age of 37 years old ranging from 18 to 65. The causes of injuries included mangled injury in 22 cases,high fall injury in 10 cases,cut injury in 5 cases,melanoma in 3 cases,decubital ulcer in 2 cases. Of the 42 cases,27 were on left side and 15 on right side. The defect area of skin ranged from 3 cm× 2 cm to 18 cm×16 cm. The time between the injury and surgery ranged from 8 hours to 10 years. The wounds were repaired separately by medial plantar flap in 13 cases,lesser saphenous sural nerve vascular island flap in 18 cases,saphenous neurocutaneous vascular flap in 11 cases. The patients' outcome were evaluated with appearance,blood supply,texture,resilience and two points discrimination of the flaps.Results: All of the 42 flaps were survived. The distal skin necrosis occurred in 2 flaps,but healing occurred after debridement and intermediate thickness skin grafting. Three patients with sinus formation healed after 5 to 12 months of dressing change. All patients were follow-up for 8 months to 6 years. The flaps of all patients gained a satisfied shape after operation. The patients had a normal gait,the flaps had a good sense and a resistance to wearing,and no ulcer occurred. The two point discrimination of the flap was 4 to 12 mm.Conclusion: It is convenient and effective to repair the heel skin and soft tissue defects using medial plantar island skin flap when the defects is less then 8 cm×6 cm. As reliable blood supply,major artery preservation and high survival,the lesser saphenous sural nerve vascular island flap and saphenous neurocutaneous vascular flap can be transferred to repair the large soft tissue defect of heel.