腓肠神经营养血管皮瓣的长宽比对皮瓣部分 坏死影响的157例分析

目的：探讨皮瓣长宽比对远端蒂腓肠神经营养血管皮瓣部分坏死的影响。方法：对157例远端蒂腓肠神经营养血管皮瓣的临床资料和手术图片回顾性分析。皮瓣长宽比2.83~7.14∶1。皮瓣分为A组（长宽比≤3∶1）、B组（3∶1＜长宽比＜4∶1）、C组（4∶1≤长宽比＜5∶1）、D组（5∶1≤长宽比＜6∶1）和E组（长宽比≥6∶1）。皮瓣切取采用顺逆结合法。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；部分坏死18例（11.5%）。皮瓣A组6例，部分坏死0例（0%）；B组26例，部分坏死4例（12.5%）；C组56例，部分坏死2例(3.6%);D组50例，部分坏死8例（16.0%）；E组19例，部分坏死4例（21.5%）。皮瓣部分坏死率D组高于C组，长宽比<5∶1组（A，B，C组合并）（6.8%，6/88）低于长宽比≥5∶1组（C，D组合并）（17.4%，12/69），差异均有统计学意义（均P＜0.05）。结论：远端蒂腓肠神经营养血管皮瓣的长宽比＜5∶1时，皮瓣部分坏死的可能性较低，成活较可靠；成活皮瓣的长宽比最大可达6~7∶1。

Effect of length-width ratio on partial necrosis in distally based sural neurofasciocutaneous flap: 157 cases

ObjectiveTo explore the effect of length-width ratio (LWR)on partial necrosis in distally based sural neurofasciocutaneous flap.MethodsClinical data and operative pictures of 157 distally based sural neurofasciocutaneous flaps were reviewed and analysed. LWR of the flaps ranged from 2.83∶1 to 7.14∶1. Based on the LWR of the flaps,the flaps were divided into 5 groups： Group A(LWR≤3∶1), Group B（3∶1＜LWR＜4∶1），Group C（4∶1≤LWR＜5∶1）, Group D（5∶1≤LWR＜6∶1） and Group E （LWR≥6∶1）.The flaps were harvested by antegrade-retrograde combined method.ResultsOf the 157 flaps,125 survived uneventfully,8 had distal epidermical necrosis,wound dehiscence occurred in 6 flaps，18 flaps（11.5%） had distal partial necrosis.Partial necrosis occurred in none of the 6 flaps in Group A(0%),4 of 26 flaps in Group B(12.5%), 2 of 56 flaps in Group C (3.6%), 8 of 50 flaps in Group D (16.0%),and 4 of 19 flaps in Group E(21.5%).There were no statistical differrences in partial necrsis ratio between Group A and B, Group B and C, Group D and E（P＞0.05）. Partial necrosis ratio was higher in Group D than that in Group C(P＜0.05). It was lower in the LWR＜5∶1 group (Group A+Group B+Group C) (6.8%，6/88) than that in the LWR≥5∶1 group (Group D+Group E) (17.4%，12/69) (P＜0.05). ConclusionWhen LWR of the flap is less than 5∶1,probability of partial necrosis occurring in distally based sural neurofasciocutaneous flaps is low, and the flap can survive more reliably. The maximum LWR of the surrival flaps can reach 6-7∶1.