低旋转点的隐神经营养血管远端蒂皮瓣的临床应用

目的探讨低旋转点的隐神经营养血管远端蒂皮瓣的临床应用。方法 2005年1月~2011年11月,笔者应用低旋转点的隐神经营养血管远端蒂皮瓣,修复前足或达前足处的足背皮肤软组织缺损创面26例,对手术治疗的方法、注意事项进行总结分析。结果 24例皮瓣完全成活,创面Ⅰ期愈合;2例皮瓣术后2 d皮瓣远端出现肿胀、水疱,经抬高患肢及拆除皮瓣远端过紧缝线等处理后,皮瓣远端逐渐出现浅表坏死,经换药后愈合;供区植皮全部成活,切口Ⅰ期愈合。术后随访6～24个月,皮瓣厚薄、颜色、质地接近受区,按照国际手外科联合会制定的感觉功能分级标准:皮瓣感觉恢复至S5级14例,皮瓣感觉恢复至S4级12例。骨折均于术后8～12周愈合。患足负重行走正常,皮瓣及植皮区皮肤无破溃。结论低旋转点的隐神经营养血管远端蒂皮瓣的临床应用具有较好的效果,值得广泛推广和应用。

Clinical application on low rotation point of the saphenous neurocutaneous vascular distally based flap

Objective To investigate the low rotation point of the saphenous neurocutaneous vascular distally based flap of clinical applications.Methods January 2005 to November 2011,we applied a low rotation point saphenous neurocutaneous vascular distally based flap in the foot or up to the front foot at the instep skin and soft tissue wounds of 26 cases,the method of surgical treatment,attention the matters summarized and analyzed.Results 24 flaps survived completely,healing wounds Phase Ⅰ;two cases flaps 2 d distal swelling,blisters,by raising limb and removing the distal tight sutures after treatment,the skin flap distal superficial necrosis gradually healed after changing dressing;the donor site skin graft survival of all incision phase Ⅰ of the healing.Patients were followed up for 6 to 24 months;flap thickness;color;texture;close to the subject area;in accordance with the sensory function of grading standards developed by the International Federation of Hand Surgery:the flap sensory recovery to S5 level of 14 cases,the flap sensory recovery to S4 12 cases.All fractures healed in 8 to 12 weeks after surgery.The affected foot weight-bearing walking normal,the skin flap and skin graft area without ulceration.Conclusion The low rotation point of the saphenous neurocutaneous vascular distally based flap of clinical applications with good results,worthy of extensive promotion and application.