不同皮神经营养血管皮瓣的临床应用

目的观察不同皮神经营养血管皮瓣的临床效果。方法根据病例骨外露或肌腱外露的创面,选择应用皮瓣种类:腓肠神经营养血管逆行皮瓣96例,隐神经营养血管逆行皮瓣35例,拇指尺背侧皮神经营养血管逆行岛状皮瓣35例,手背皮神经营养血管逆行岛状皮瓣2例,前臂外侧皮神经逆行皮瓣15例,股中间神经营养血管逆行皮瓣5例,肋间皮神经营养血管皮瓣3例,股后侧皮神经逆行皮瓣6例,足背内侧皮神经营养血管皮瓣6例,足背中间皮神经营养血管皮瓣10例,足背外侧皮神经营养血管皮瓣3例。其中皮瓣面积最大32 cm×10 cm,最小2 cm×3 cm。皮神经血管蒂最长18 cm,最短2 cm,蒂最宽4 cm,最窄1 cm。旋转度最大180°,最小90°。结果临床应用216例,其中201例皮瓣全部成活,15例皮瓣远端部分坏死,经换药、植皮后愈合。结论皮神经营养血管皮瓣血供可靠,切取简单,适用于四肢及躯干损伤创面的修复。

Clinical application of different neurocutaneous vascular flaps

Objective To investigate the clinical effects of neurocutaneous vascular flaps.Methods Two hundred and sixteen cases of limbs and trunk injuries were treated with variable neurocutaneous vascu- lar flaps.Injuries were the results of motorcycle accidents(n=98),bruise(n=59),post-operational bone infections(n=23),machinery accidents(n=32),electric injury(n=2),radiation(n=1)and tumor(n =1).The injury parts involved anterior leg(n=98),dorsal foot(n=11),metatarsal and forefoot(n=19), heel and plantar foot(n=22), knee and thigh(n=11),distal forearm(n=10),wrist(n=3),dorsal hand(n=2),thumb(n=35),finger(n=2)and thorax and back(n=3).All the cases in this study had exposed bones or tendons.The flaps involved sural neurocutaneous vascular flap(n=96),saphenous neuro- cutaneous vascular flap(n=35),ulnodorsal thumb neuroeutaneous vascular flap(n=35),reverse dorsal manus neuroeutaneous flap(n=2),lateral forearm neurocutaneous vascular flap(n=15),middle thigh neu- rocutaneous vascular flap(n=5),intercostal neurocutaneous vaseulr flap(n=3),posterior thigh neurocuta- neous vascular flap(n=6),medial dorsal pedal neurocutaneous vascular flap(n=6),intermediate dorsal pedal neuroeutaneous vascular flap(n=10)and lateral dorsal pedal neurocutaneous vascular flap(n=3). Results Two hundred and one flaps survived uneventfully,while 15 flaps had partial necrosis in the distal margin and were treated with dressing change and skin graft.Conclusion The neurocutaneous vascular flaps are suitable for repairing limbs and trunk injuries due to their steady blood supply and easy harvest.