带蒂皮瓣修复小腿皮肤软组织缺损的术式选择

目的探讨比较带蒂皮瓣修复小腿皮肤缺损的四种手术方法的临床应用价值。方法1996-07～2003-12,笔者所在医院对52例小腿皮肤软组织缺损骨外露患者,应用腓肠神经筋膜蒂皮瓣、隐神经筋膜蒂皮瓣、腓肠肌内侧头(或外侧头)皮瓣、小腿内侧皮瓣等4种手术方法移植修复。结果52例皮瓣全部成活,5例少部分坏死,经换药或少量植皮后,创面全部愈合。术后随访3～24个月,均取得良好效果。结论皮神经筋膜蒂皮瓣手术方法简便,皮瓣血供良好,适合应用在创面基底条件较好,面积较小的皮肤缺损。腓肠肌内侧(或外侧)头皮瓣手术方法简便,皮瓣血供丰富,适合应用在创面条件差、组织缺损多的创面,但外形臃肿,影响美观。小腿内侧皮瓣,手术操作较复杂,破坏一条主要血管,但皮瓣血供丰富,可切取面积较大。在临床工作中,应根据患者不同病情及局部皮肤软组织的条件,选择恰当的手术方法,应用适合的带蒂皮瓣转移修复小腿皮肤软组织缺损。

Comparison of four procedures for repairing skin and soft tissue defects of leg with pedicled flaps

Objective To compare and evaluate the four procedures in repairing skin and soft tissue defects of leg with pedicled flaps. Methods From July 1996 to December 2003, 52 cases with skin and soft tissue defects with bone exposed in leg were treated respectively by four operative methods i.e, with the sural neurocutaneous island flap,saphenous neurocutaneous island flap,gastrocnemius musculocutaneous flap or lower medial leg fasciocutaneous flap. Results All the flaps survived. In 5 cases,necrosis appeared on the distal edges of flaps and then healed up gradually through dressing change or grafted skin. Satisfactory results of appearance and functions were achieved after follow-up of 3 months to 2 years. Conclusions The fasciocutaneous flap pedicled with nutrient vessels of the cutaneous nerve is a simple and safe method for repairing defects in good bedding and small site. The musculocutaneous flap pedicled with gastrocnemius musculus is a simple and safe method for repairing defects in bad bedding and large site. But the appearance is overstaffed. The operation of the lower medial leg fasciocutaneous flap may be complex in manipulation and destroy a main artery,but the flap is reliable and the site can be larger. In clinical practice,the selection of the fitable operative method should better depend on the diference of the skin and soft lissue defect in each patient.