重建感觉的腓肠神经营养皮瓣修复足跟部缺损的临床研究

目的 利用腓肠神经皮瓣所带的腓肠神经内侧支和外侧支与创面周围胫神经端侧缝合,重建皮瓣的感觉以及恢复足背外侧感觉,以解决患者足踝部感觉缺失的痛苦并恢复覆盖足跟皮瓣的感觉.方法 1999年8月-2007年8月,收治足跟部皮肤软组织缺损25例(27足),进行腓肠神经营养血管皮瓣移植,其中14例行腓肠神经营养皮瓣与腓动脉皮瓣联合皮瓣移植.切取皮瓣时,在腓肠神经近端多取1～3cm.腓肠神经内侧支和外侧支,断端与胫神经行端侧缝合.术后6～9个月随访,按照感觉检查分级标准把皮瓣和足背外侧感觉恢复情况分成S_1～S_55级,并按感觉恢复范围分成R_1,小于25%;R_2,25%～50%;R_3,50%～75%;R＿4,75%～100%.结果 术后随访6～9个月,皮瓣及足背外侧皮肤感觉恢复情况:S_46足、S_318足、S_23足.皮瓣及足背外侧感觉恢复范围:R_412足、R_315足.结论 作腓肠神经营养皮瓣移植时行腓肠神经与创面周围胫神经端侧缝合手术简单,对胫神经无不良影响,而皮瓣和足背外侧感觉恢复较好.腓肠神经营养皮瓣与腓动脉皮瓣的联合皮瓣切取面积大,对大面积的足部皮肤缺损是一种理想的方法.

Clinical study on reconstruction of tissue defect of the heel using sensate sural neurovascular flap

Objective To restore sensation of the sural neurovascular flap and the lateral dorsum of the foot by end-to-side coaptation of the medial and lateral branch of the sural nerve in the flap to the tibial nerve in the defect area. Methods From August in 1999 to August in 2007, 25 patients (27 feet) who had soft tissue defect of the heel were treated with sural neurovascular flap transfer. 14 of these patients had combined fibular artery flap transfer as well. During flap harvesting 1 to 3 cm long medial branch and lateral branch of the sural nerve were dissected to be included in the flap. These sural nerve branches were sutured to the tibial nerve in an end-to-side fashion. About 6 to 9 months later, all the patients were followed for evaluation of sensory recovery of the flap and the lateral dorsum of the foot. Sensory recovery was graded as S_5 to S_5. The area of recovery was grades as R_1: < 25%, R_2: 25% to 50% , R_3: 50% to 75% , R_4: 75% to 100% . Results 6 to 9 months postoperatively, sensory recovery of the skin flap and the lateral dorsum of the foot reached S_4 in 6 feet, S_3 in 18 feet, S_2 in 3 feet and R_4 in 12 feet, R_3 in 15 feet. Conclusion End-to-side coaptation of the medial and lateral branch of the sural nerve to the tibial nerve in sural neurovascular flap transfer is an easy and effective method to restore sensation of the flap and dorsum of the foot. Sural neurovascular flap combined with fibular artery flap have a large surface area that can be used to cover large soft tissue defect of the foot.