应用腓动脉穿支腓肠神经营养血管皮瓣修复小腿及足踝部创面

目的　探讨腓动脉穿支腓肠神经营养血管皮瓣修复小腿及足踝创面的临床疗效。 方法 2017年1月至2019年1月，应用腓动脉穿支腓肠神经营养血管皮瓣治疗小腿和足踝创面患者15例，其中男性患者11例，女性患者4例，年龄14~65岁，平均年龄39岁。小腿创面6例，足踝创面9例。创面大小9 cm×4 cm~26 cm×5 cm，采用腓动脉穿支腓肠神经营养血管皮瓣修复。皮瓣供区直接缝合，如缝合张力过大则采取植皮修复供区创面。术后予以制动、抗炎、抗血栓形成、抗血管痉挛、消肿、保暖等治疗，术后随访皮瓣成活情况、创面修复效果。 结果　切取皮瓣大小10 cm×5 cm~27 cm×7 cm，术后随访6~22个月，平均13个月。14例皮瓣成活，1例皮瓣术后出现静脉回流障碍，皮瓣远端部分坏死，后期清创后植皮修复创面愈合良好；9例足踝创面患者踝关节屈、伸功能轻度受限；2例胫骨开放性骨折经外固定治疗出现骨折不愈合，经改钢板螺钉内固定治疗后愈合；2例患者皮瓣臃肿，影响穿鞋，二期行皮瓣修整后改善。 结论　腓动脉穿支腓肠神经营养血管皮瓣是修复小腿及足踝创面的良好选择。

Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for repairing lower leg and ankle soft-tissue defects

Objective　To evaluate the clinical efficacy of peroneal perforator-plus pedicled sural neurofasciocutaneous flap in the reconstruction of lower leg and ankle soft-tissue defects.　Methods　Clinical data were collected from January 2017 to January 2019. Total 15 cases were involved in this study, all including the lower leg and ankle soft-tissue defects and were treated with the peroneal perforator-plus pedicled sural neurofasciocutaneous flap. The patients involves 11 males and 4 females. Range of age was from 14 to 65 (average 39 years). There were 6 cases of lower leg wound and 9 cases of ankle wound. Repair of wounds was with peroneal perforator-plus pedicled sural neurofasciocutaneous flap. The size of the soft-tissue defects ranged from 9 cm×4 cm to 26 cm×5 cm. The donor area site was sutured directly. If the tension of donor site was large, the skin graft was done to the site. After surgery, patients were taken routine treatment manners of immobilized, intravenous antibiotic, antithrombotic, antivasospasm, antiinflammatory and keep flap site warming. The flap survival and the effect of the reparations of the skin and soft tissue defect were observed during follow- up period.　Results　The flap size ranged from 10 cm×5 cm to 27 cm×7 cm. The patients were followed up for 6 to 22 months, with a mean of 13 months. 14 cases of the flap survived, 1 case with the venous reflux, the distance portion of the flap suffered from necrosis and second time wound debridement done, and the skin graft applied, the repair site healed well. 9 cases of ankle and foot ulcers represented as ankle joint dorsiflexion and plantar flexion slightly limited. 2 cases of tibial open fracture were treated with external fixation, and non-union occurred and changed to internal plate fixation and fracture union. 2 cases affected flap extruded from the wound site and inconvenient for shoeing, and the flap transformed and improved.　Conclusions　The peroneal perforator-plus pedicled sural neurofasciocutaneous flap in the reconstruction of the lower leg and foot defect is a good surgical intervention.