逆行腓肠神经营养血管皮瓣在足跟部软组织缺损中的应用

目的报道逆行腓肠神经营养血管皮瓣在足跟部软组织缺损中的应用，探讨小隐静脉在皮瓣血液循环中的作用。方法自2001年3月至2007年3月，共收治足跟部软组织缺损患者20例，年龄12～72岁，平均36岁，其中男14例，女5例。外伤件缺损12例，足跟部慢性溃疡5例，足跟部鳞状细胞癌患者3例。将足跟部创面清理后，采用逆行腓肠神经营养血管皮瓣修复创面。皮瓣切取面积最大9cm×12cm，最小5cm×6cm。其中自皮瓣远端结扎小隐静脉12例，未结扎8例。结果术后所有患者皮瓣均成活。未结扎小隐静脉组患者1例皮瓣周缘出现发黑坏死，该患者皮瓣切取面积为8cm×12cm，采用隧道方式转移皮瓣。嘱患者俯卧位，抬高患肢，反复换药后痊愈。随访1～6年，1例鳞癌患者术后7个月死亡，其余患者皮瓣外形满意，功能良好。结论腓肠神经营养血管皮瓣是修复足跟部软组织缺损的一种理想方法。小隐静脉结扎与否不是皮瓣存活的必须条件。

The clinical application of super sural neurofasciocutaneous flaps in heel reconstructions

Objective To study the clinical application of super sural neurofasciocutaneous flaps in heel reconstructions and discuss the ability of the lesser saphenoas vein. Methods From March 2003 to March 2007, 20 cases, male 14, femal 5, 12 to 72 years old （ average 36 - year - old）, underwent reversed saphenoas fasciocutaneous island flap after wide excision of heel lesion. The causes of heel lesions in 12 patients were posttraumatic, 5 cases were charonic ucler, 3 eases resulted from tumor resection. The smallest flap was 5 cm ×6 cm and the largest was 9 cm × 12 cm. In 12 cases, the lesser saphenous vein were cut, 8 cases were not. Results Follow - up ranged from 1 to 6 years, 1 case with tumor was died after the operation. One cases developed partial superficial necrosis postoperation. None of the patients complained of any functional problem related to the flap. Conclusion The sural island flap is a reliable, safe, and easy method of providing soft tissue coverage in the heel. Lesser saphenous vein is not the necessory condition to the flap＇s survival.