28例腓动脉主穿支蒂腓肠神经营养血管皮瓣修复跟腱区创面的护理

报告了28例腓动脉主穿支蒂腓肠神经营养血管皮瓣修复跟腱区创面患者的围手术期护理.腓动脉主穿支蒂腓肠神经营养血管皮瓣在修复跟腱区创面时充分分离显露穿支,旋转180°后,远、近端交换覆盖创面,但是穿支蒂部细小,易受牵拉或压迫等刺激,围手术期护理尤其重要.术前加强术前饮食、体位、排便及运动等各方面指导,注意保护皮肤,术后帮助患者取有效、舒适体位,保护皮瓣蒂部,积极进行功能锻炼.本组出现1例血管危象,经及时处理后,全部皮瓣存活.     

选择不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损

目的选择不同供血方式的小腿后外侧带蒂皮瓣修复足踝部皮肤软组织缺损,并观察临床治疗效果。方法采用前瞻性研究方式选择收治的79例足踝部皮肤软组织缺损患者作为研究对象,根据不同缺损形式分别给予不同方式的小腿后外侧带蒂皮瓣进行修复:58例足踝部软组织缺损患者分别行腓肠神经营养血管皮瓣修复术(45例)与腓动脉穿支蒂腓肠神经营养血管皮瓣修复术(13例),8例足跟部软组织缺损患者行感觉重建的腓动脉穿支蒂腓肠神经营养血管皮瓣修复术,7例前踝、外踝、后踝软组织缺损患者行腓动脉穿支皮瓣修复术,6例前足背软组织缺损患者行腓动脉及穿支供血为蒂的腓肠神经营养血管皮瓣修复术。观察修复效果。结果所有患者均获得随访,平均随访时间21个月,45例行腓肠神经营养血管皮瓣修复术者有5例出现部分坏死,换药处理之后均全部成活;其余行皮瓣修复术者均全部成活;8例行感觉重建的腓动脉穿支蒂腓肠神经营养血管皮瓣修复术者,感觉测定S0、S1;所有患者的移植皮瓣成活良好,行走功能正常。结论足踝部皮肤软组织缺损的程度、大小、位置以及周围血管应是确定皮瓣选取的综合考量因素,以此选择安全性最高、操作最简单、损伤最小的皮瓣修复缺损部位,既可以降低手术对患者健康机体的损伤程度,也可以提高皮瓣的成活率,获得良好的手术效果。     

小腿穿支血管筋膜蒂皮瓣修复胫骨外露创面的围术期护理

目的 探讨小腿穿支血管筋膜蒂皮瓣修复外露创面的护理措施.方法 总结32例小腿穿支血管筋膜蒂皮瓣修复筋骨外露创面术后患者的护理方法及措施,观察护理效果.结果 本组除1例患者皮瓣远端部份坏死结痂外,其余患者皮瓣均成活.经随访,皮瓣外形、血供满意,功能恢复较理想.结论 严密细致的观察和行之有效的护理措施是患者皮瓣修复手术成功的重要保障.     

游离腓动脉穿支动脉皮瓣修复手足皮肤缺损

目的 探讨应用游离腓动脉穿支动脉动脉皮瓣修复手足软组织缺损的方法和临床效果.方法 对32例手足皮肤缺损应用游离腓动脉肌皮穿支动脉动脉皮瓣修复.切取面积从5.0 cm×4.5 cm～12 cm×9 cm.其中28例以肌皮穿支动脉动脉为蒂,4例以肌间隔穿支动脉为蒂.动脉血管蒂与受区采用端侧吻合或端端吻合.结果 术后皮瓣全部成活.1例术后发生动脉危象,经重新吻合后成活.随访6月～2年,皮瓣略臃肿,外观及弹性良好.结论 腓动脉穿支动脉动脉皮瓣的血管解剖恒定、皮瓣厚薄适中,操作较腓动脉皮瓣简化,是修复手部及足背远端软组织中小面积缺损的有效方法.     

胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损

选择 2003-02/2007-02于福州总医院骨科应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损的患者16例,在解剖学基础上,设计胫后动脉穿支筋膜蒂皮瓣,轴线在胫骨内侧髁后与内踝、跟腱间中点的连线,旋转点在最邻近创面、其蒂部在有胫后动脉穿支的轴线上.根据术前超声多普勒血流仪穿支探测,要求皮瓣、蒂部及穿支表面有良好的皮肤.顺行设计皮瓣修复小腿上段,逆行设计修复小腿中下段,其中小腿下段9例,小腿中段3例,小腿上段4例.皮肤软组织缺损范围为2.0 cm×1.5 cm～12.5 cm×7.5 cm,胫后动脉穿支筋膜蒂皮瓣最大面积为15.0 cm×10.0 cm,最小为4.0 cm×2.5 cm.观察其修复效果.术后皮瓣均成活.有2例远端部分皮肤坏死,但其皮下有肉芽生长,其中1例经换药愈合,1例用中厚皮植皮愈合.所有病例均随访半年以上,患肢正常步态行走,有痛觉.应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损,供区在小腿内后侧,损伤后蒂部保存良好,切取便利,不损伤主要血管,血供可靠,成活率高,是修复小腿皮肤软组织缺损的首选术式之一.     

超声多普勒血流探测在腓动脉穿支岛状皮瓣设计中的应用

目的探讨超声多普勒血流探测在腓动脉穿支岛状皮瓣设计中的临床应用价值。方法选取我院2008年6月～2012年6月收治61例应用腓动脉穿支皮瓣修复小腿足踝部患者的临床资料,根据术前是否应用超声多普勒探测血流分为对照组及观察组,其中对照组31例,观察组30例。对照组术前未应用超声检测皮瓣血管;观察组术前经多普勒血流探测并测出其速度及波形。结果观察组术中测得穿支动脉起始处内径平均为0.92±0.21 mm,收缩期峰值流速(PSV)平均为0.18±0.07m/s,皮瓣筋膜蒂长度平均为8.31±3.34cm,皮瓣成活30例,成活率为100%,术中测得皮瓣筋膜蒂长度为5.13±2.42cm;对照组皮瓣成活27例,成活率为90%。两组皮瓣筋膜蒂长度及皮瓣成活率相比较均具有统计学意义(P<0.05)。结论应用超声多普勒血流探测能够选择一定流速的腓动脉穿支作为血管蒂,能够显著提高皮瓣成活率。     

腓肠神经逆行复合组织蒂明道行走皮瓣修复小腿及足部创面

目的观察腓肠神经逆行复合组织蒂明道行走皮瓣修复小腿及足部创面的疗效。方法对10例小腿及足部创伤患者采用腓肠神经逆行复合组织蒂皮瓣修复,皮瓣蒂部筋膜面植中厚皮片,采用腓肠神经逆行营养血管、穿支节断血管、筋膜蒂、皮下组织、真皮下血管网混合蒂及皮瓣蒂筋膜面植皮等供血系统,蒂部明道行走。结果 10例患者术后3周皮蒂部夹蒂试验血运无影响后,5例在院内断蒂,5例出院后6～8周来院断蒂。皮瓣均全部成活,其中7例患者获1～3年随访无慢性溃疡发生,患肢功能恢复良好;3例失访。结论腓肠神经逆行复合组织蒂明道行走皮瓣修复小腿及足部创面操作方便,是一种可选用的治疗办法。     

远端蒂皮神经营养逆行皮瓣修复足踝部软组织缺损

目的:探讨应用多种神经营养血管逆行皮瓣治疗足踝部软组织缺损的临床效果.方法:应用以腓动脉、胫前动脉或胫后动脉穿支为远端蒂的神经营养血管逆行皮瓣修复足踝部缺损41例.皮瓣面积6 cm×5 cm～23 cm×16cm.结果:术后39例皮瓣Ⅰ期存活,1例出现皮瓣远端部分坏死,经换药植皮后痊愈;1例出现皮瓣下脂肪液化,经Ⅱ期清创再缝合后痊愈.随访1～12个月,1例足跟皮瓣由于负重出现缝合处瘢痕愈合,其余40例功能及外观恢复满意.结论:神经营养血管蒂岛状皮辫具有血液供应可靠、操作简单、成活率高以及不牺牲重要血管等特点,是修复踝部、足跟部、足背及足内侧皮肤软组织缺损的理想方法之一.     

腓肠神经营养血管皮瓣的临床应用

目的探讨腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部软组织缺损,交腿转移修复对侧足踝部缺损的临床应用效果.方法在应用解剖基础上,设计带筋膜蒂的腓肠神经营养血管岛状皮瓣,逆行应用修复足背、足跟、足底及踝部软组织缺损,同时观察皮瓣的可切取范围、血液供应及静脉回流情况、营养血管在外踝上与腓动脉穿支相交通的位置及血管蒂隧道的处理方案.结果临床应用 21例,其中修复足背软组织缺损 8例、足跟软组织缺损 4例、足底软组织缺损 2例,外踝及足背联合缺损 3例及对侧足踝部软组织缺损 4例.皮瓣最大面积 15cm× 9.5cm,除 2例远侧皮缘部分坏死,全部成活.结论腓肠神经营养血管皮瓣血液循环丰富,成活率高,不牺牲主要血管神经,是修复足背、足跟、踝部及足底软组织缺损的理想皮瓣.     

带腓肠神经伴行血管蒂筋膜皮瓣修复小腿及足踝部软组织缺损创面38例临床分析

目的:总结带腓肠神经伴行血管蒂筋膜皮瓣修复小腿及足踝部软组织缺损创面的临床效果。方法:回顾性分析2003年8月至2012年8月我科应用带腓肠神经伴行血管蒂筋膜皮瓣修复小腿及足踝部软组织缺损创面38例的临床资料。结果:35例术后皮瓣全部成活,创面一期愈合;3例皮瓣远端部分坏死,经清创换药、游离植皮后愈合。平均住院25天,术后30例经6个月至5年随访,皮瓣质地优良,外观与足踝关节功能恢复满意,感觉神经也部分恢复。结论:带腓肠神经伴行血管蒂筋膜皮瓣修复小腿及足踝部软组织缺损创面的临床效果好。     

Large mycotic aneurysm of the peroneal artery

We describe the case of a 37-year-old patient with mycotic aneurysm of the right peroneal artery associated with episodes of endocarditis. There are only 7 cases of mycotic aneurysms of the crural arteries reported in the literature. To the best of our knowledge, this is the first reported case of a mycotic aneurysm of the peroneal artery in an adult.     

Localizing peroneal nerve lesions

The main result of a peroneal nerve lesion, foot drop, is so obvious that few patients can ignore its presence. However, the detailed knowledge of peroneal nerve anatomy needed to localize the lesion may tax even a seasoned clinician. Examination of the strength of five muscles--the tibialis anterior, peroneus longus and brevis, posterior tibial, gluteus medius and quadriceps--provides information necessary to localize the site of the neuropathy. This tentative localization can be confirmed by electromyography. Treatment is directed to the cause of the lesion and stabilization of the ankle if necessary.     

US in peroneal tendon tear

Peroneal tendon injuries are common also due to the recent increase in sports participants involved in amateur activities. Clinical evaluation generally provides a diagnosis, but diagnostic imaging is often required to confirm a clinical suspicion and make correct management decisions. Ultrasound (US) imaging is the method of choice in the study of peroneal tendon injuries due to the high resolution of the images and the possibility of performing dynamic studies. US is furthermore non-invasive and inexpensive and provides the possibility of performing US-guided steroid infiltration of the tendon sheath or the surrounding tissues. The present paper will address the normal anatomy of the peroneal tendons and related structures, US imaging techniques and the various conditions and injuries which may affect this anatomic region. Also more expensive imaging techniques, such as computed tomography and magnetic resonance imaging, will be mentioned as well as their indications; however, they are required only in rare cases in which diagnosis remains uncertain or for pre-operative assessment.     

Ultrasonography of the peroneal nerve muscle group in normal subjects and patients with peroneal paresis

A method for measuring the cross-sectional area (CS area) of the peroneal nerve muscle groups (PNMG) by ultrasonography is presented. The method has a good reliability and can be performed easily. The mean value of the ratio (x 100) of the right-sided PNMG CS area to the left-sided PNMG CS area in right-handed normal subjects was 98%, with a standard deviation of 8.5%. The normal range for this value was 81%-115% (mean +/- 2 SD). Examples of these measurements in patients with peroneal pareses during denervation and reinnervation are given.     

Evaluation and treatment of peroneal neuropathy

Peroneal nerve compromise results in the clinical complaint of weakness of the ankle dorsiflexors and evertors. This peripheral origin of foot drop has been reported due to numerous traumatic and insidious causes. Traumatic causes of nerve injury occur in association with musculoskeletal injury or with isolated nerve traction, compression, or laceration. Insidious causes include mass lesions and metabolic syndromes. The peroneal nerve is most commonly interrupted at the knee. However, the sciatic and peroneal nerves may be compromised at the hip and ankle as well. This article reviews the anatomical origin of the nerve, the etiologies of possible nerve damage, evaluation of the patient with peroneal nerve injury, and treatment of this disorder.     

Functional outcome after peroneal nerve injury

The objective of this study was to describe muscle strength, ankle-foot orthosis (AFO) use, walking ability, participation and quality of life in patients with peroneal nerve injury. A historic cohort study (n=27) was performed with a median follow-up time of 61 months (inter quartile range 37-91). Muscle strength was assessed using the Medical Research Council scale. Perceived walking ability was assessed with the Walking Questionnaire. AFO use and problems in participation were assessed with a structured interview. The RAND-36 Health Survey was used to evaluate health-related quality of life. Muscle strength improved significantly during follow-up but 62% (16 of 26 patients, one missing value) of the patients still had paresis to some degree of ankle dorsiflexors. AFO use decreased significantly but 11% (n=3) still used an AFO at follow-up. Two-thirds (n=18) of the study population experienced some limitations in walking and climbing stairs. Decreased maximum walking distance was reported by 59 % (n=16). About half of the patients (n=13) reported some restrictions in leisure activities and 47% (n=9) of the patients with a paid job (n=19) experienced some restrictions in work. Scores on the domains physical functioning, mental health, vitality, bodily pain and general health perception of the RAND-36 were significantly lower compared with a Dutch reference group. Limitations in walking ability and participation are frequently present 5 years after peroneal nerve injury. Health-related quality of life was lower than in a reference group.     

Reliability of peroneal reaction time measurements

OBJECTIVE: The purpose of this study was to demonstrate the reliability of reaction time-measurements on a tilting platform under consideration of various influencing factors. DESIGN: The peroneal reaction time of 30 healthy subjects was examined in an experimental study. BACKGROUND: Peroneal reaction time measurements have been used to objectively evaluate functional instability of the ankle joint, but the reliability of the method has not been proven yet. METHODS: The reaction time after sudden inversion of the ankle were determined by surface EMG. RESULTS: The median latency of the peroneus brevis was 66 ms and that of the peroneus longus was 63 ms. No differences between male and female subjects and between left and right legs could be found. An increase of reaction time was caused by neuromuscular fatigue (P=0.033, for both the peroneus brevis and the peroneus longus). A decrease in reaction time resulted if the foot was held in 15 degrees of plantar flexion (P=0.0004 for the peroneus brevis, P=0.002 for the peroneus longus). The reliability was examined by circadian and by day-to-day measurements. The coefficient of correlation (Spearman's rho) between the peroneus brevis and days 1-5 was 0.67 (P=0.177) and for the peroneus longus 0. 00 (P0.999). The same results were obtained after the circadian measurements. CONCLUSION: Determination of peroneal reaction time was proven as a reliable measurement method. RELEVANCE: Reliability and validity are basic preconditions of a test to become accepted as a clinical measurement method. This paper demonstrates the reliability of measuring the peroneal reaction time. Thus, assuming validity, the peroneal reaction time measurement is justified as a clinical test.     

Missed acute isolated peroneal compartment syndrome

This paper outlines 3 cases of acute isolated peroneal (lateral) compartment syndrome following exertion, minor trauma or overuse. Compartment syndromes are usually associated with crush injuries or fractures; they are an uncommon development following minor trauma or overuse. In acute isolated peroneal compartment syndrome the diagnosis is often delayed, resulting in permanent impairment. Persistent or worsening pain following a minor injury or overuse is typical, and the initial physical findings are often nonspecific, although swelling and tenderness out of proportion to the described injury are common. Marked increase in pain with passive inversion and dorsiflexion of the ankle should suggest the diagnosis. In cases that present late or where the diagnosis is initially missed, there is often a common peroneal nerve palsy. As with all compartment syndromes, prompt diagnosis and surgical decompression is necessary to prevent permanent impairment.