低旋转点外踝上皮瓣修复前足创面的临床应用

目的探讨低旋转点外踝上皮瓣在修复前足皮肤软组织缺损中的应用。方法2007年3月－2010年5月收治前足皮肤软组织缺损39例，均为外伤性前足软组织缺损，合并骨与关节损伤13例。伤后常规清创，确定胫前动脉、胫后动脉是否完好，设计皮瓣并应用低旋转点外踝上皮瓣修复缺损。结果所有皮瓣成活，1例术后2d皮瓣远端出现静脉危象，拆除旋转点处皮肤缝线后皮瓣恢复正常，4例皮瓣远端皮肤部分浅表性坏死，经换药处理后二期愈合。本组随访6个月～2年，皮瓣外观、质地优良，无色素沉着、瘢痕挛缩等情况，9例足背外侧皮肤感觉减退，考虑为术中损伤腓浅神经所致。结论低旋转点外踝上皮瓣切取较简单，成活率高，是修复前足皮肤缺损的一种理想术式。

Clinical Application of Sub-pivoting Point Extramalleolus Epithelial Skin Flap in Repairing Soft Tissue Defects of the Forefoot

Objective To explore the clinical effect of sub-pivoting point extramalleolus epithelial skin flap in repairing the soft tissue defects of the forefoot.Methods 39 patients with the soft tissue defects in forefoot admitted during March 2007 and May 2010 were traumatic soft tissue loss in proleg,13 patients combined with injury of the bone and joint.Ordinary debridement was done and integrity of anterior and posterior tibial artery was assured.We designed the skin flap and used sub-pivoting point extramalleolus epithelial skin flap in repairing defects.Results All the flaps survived.Veins articulo appeared at distal end of 1 patient’s skin flap 2 d after operation,and the skin flap was put back after demolishing suture line of skin of pivoting point.The distal skin necrosis occurred in 4 skin flaps,and secondary healing came after changing dressings.We observed appearance of skin flap,texture,pigmentation and cicatricial contracture 6 months-2 years postoperative.9 patients’ Cutaneous sensation bated due to intraoperative superficial peroneal nerve injury.Conclusion It is an effective method in repairing the soft tissue defects in the forefoot to cut sub-pivoting point extramalleolus epithelial skin flap.