隐神经营养血管皮瓣的临床应用

目的探讨不同类型隐神经营养血管蒂皮瓣的临床应用效果。方法1998年5月-2008年3月，对51例小腿近、远端及踝部的皮肤缺损创面，根据不同缺损部位分别采用隐神经营养血管近端蒂皮瓣（14例）、远端蒂皮瓣（37例）移位修复。结果近端蒂皮瓣14例全部成活，皮瓣质地、外形、感觉功能恢复满意；远端蒂皮瓣37例，其中33例全部顺利成活，3例远端1／4坏死，经换药对症治疗后愈合。1例皮瓣仅筋膜成活，经植皮愈合。随访10-23月，皮瓣质地优良，外形满意，肤色接近受区。吻合神经的11例，感觉功能恢复S4级6例，S3级4例，未吻合神经的均恢复保护性感觉。结论隐神经营养血管蒂皮瓣设计灵活多样，切取简单快捷，血供可靠，不牺牲主干血管，是修复小腿远、近端及足踝部皮肤软组织缺损创面的理想皮瓣。

Clinical application of saphenous neurocutaneous vascular flap

Objective To evaluate the clinical outcomes of different saphenous neurocutaneous vascula flap. Methods From May 1998 to March 2008, according to different defect sites, 51 cases of skin defect on proximal shank, distal shank and foot ankle were treated by proximal predicle flap （14 cases）, and distant predical flap （37 cases）, of saphenous neurocutaneous vascular flap. Results All 14 proximal predicle flaps survived. The texture and appearance were good. The sensory recovery was satisfatory. And the other 37 distal predicle flaps,33 cases survived, distal 1/4 necrosis occurred in 3 cases, and after dressing change and symtomatic treatment, wound were healed. And the only fascial survived in 1 case, and healed after skin-grafting. The follow-up period ranged from 10 to 23 months. The texture and appearance of the flaps were good, the color was closed to that of the recipient sites. The sensory recovery of 11 cases with nerve coaptation： S4：6 cases, S3：4 cases. Conclusion It is an ideal method in repair of skin defect on proximal shank, distal shank and foot ankle by saphenous neurocutaneous vascular flap, with its simple procedure, reliable blood supply, and without injury of major vessels.