足踝部皮肤缺损的修复

目的探讨足踝部皮肤缺损的修复方法及疗效。方法2000年1月~2005年10月,对36例足踝部皮肤缺损分别采用同侧外踝上皮瓣或逆行腓肠神经营养皮瓣修复,其中男35例,女1例。年龄6~62岁,平均38岁。损伤原因:机器伤12例,车祸伤22例,感染1例,冻伤1例。其中急诊行皮瓣修复24例,12例于伤后7 d~1个月手术,修复部位包括足背、足跟、前足和内、外踝,皮肤缺损范围5 cm×4 cm~20 cm×10 cm。其中外踝上皮瓣15例15个皮瓣,切取皮瓣范围5 cm×4 cm~15 cm×8 cm;逆行腓肠神经营养皮瓣21例22个皮瓣,切取皮瓣范围6 cm×4 cm~20 cm×10 cm。就其术后疗效及两种皮瓣的成活率进行比较。结果术后外踝上皮瓣完全成活10个,完全坏死3个,尖端部分坏死2个。逆行腓肠神经营养皮瓣完全成活21个,其中3个尖端出现表皮坏死;1个在术中即出现动脉供血不足,改行其他方法修复。术后经3周~6个月随访,两种皮瓣修复后的疗效相似,皮肤质地、厚度与足踝部相接近,皮瓣的痛、触觉为S0~S1。修复足跟跖侧的两种皮瓣术后均较臃肿,皮瓣与跟骨之间存在滑动,皮瓣表面出现压迫性表皮坏死。结论外踝上皮瓣适用于内外踝部、足背近侧等距皮瓣供区较近的部位,皮肤缺损面积相对较小的创面;对于缺损较大或距离踝关节较远的足部创面,应采用逆行腓肠神经营养皮瓣,但有踝关节动脉网破坏严重时需谨慎应用。

COMPARISON BETWEEN TWO DIFFERENT REPAIRING METHODS FOR SKIN DEFECTS OF FOOT AND ANKLE

OBJECTIVE: To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. METHODS: From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwent the repairing treatment, of whom 35 were males and 1 was patients with skin defects of the foot and ankle underwent the repairing treatment, of whom 35 were males and 1 was 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defects ranged in area from 5 cm x 4 cm to 20 cm x 10 cm. The lateral supramalleolar flap was used in 15 patients (15 flaps) with a flap area of 5 cm x 4 cm-15 cm x 8 cm, and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm x 4 cm-20 cm x 10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. RESULTS: Of the 36 patients, 15 underwcnt the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis. The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. CONCLUSION: The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolar flaps is more suitable for the skin defect of a smaller area over the medial or lateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.