跟骨骨折外侧入路术后皮肤坏死缺损的治疗

目的 探讨应用逆行腓肠神经营养血管皮瓣治疗跟骨骨折外侧入路术后皮肤坏死缺损的临床疗效.方法 2009年9月-2011年12月,应用逆行腓肠神经营养血管皮瓣修复跟骨骨折外侧入路术后皮肤坏死缺损24例,创面缺损面积：3.0 cm×1.5 cm～5.0 cm×2.5 cm,皮瓣切取面积：4.0 cm×3.0 cm～6.0cm×4.0 cm,腓肠神经与受区皮神经接合重建感觉.结果 24例皮瓣全部成活,受区创口一期愈合,皮瓣供区切口一期愈合.皮瓣术后未出现明显肿胀及血管危象.随访6～15个月,皮瓣外形恢复满意,质地柔软,无臃肿,弹性好,无明显色素沉着及瘢痕挛缩,无窦道及皮肤溃疡形成,皮瓣两点辨别觉7～12mn.结论 逆行腓肠神经营养血管皮瓣具有操作简便、血运可靠、皮瓣成活率高、术后受区外观、功能恢复满意等优点,是跟骨骨折外侧入路术后皮肤坏死缺损较为理想的治疗方法.

Treatment of soft-tissue defect after the lateral approach for calcaneal fracture

Objective To investigate the application and clinical result of sural nerve flap in the wound repair after the lateral approach for calcaneal fractures. Methods From September 2009 to December 2011, 24 patients with soft-tissue defect after the lateral approach for calcaneal fractures were treated with sural nerve flap. The tissue defect with exposed tendons, the area of wound was 3.0 cm×1.5 cm to 5.0 cm× 2.5 cm. The wound were repaired with sural nerve flaps of 4.0 cm×3.0 cm to 6.0 cm×4.0 cm at size. Micro-anastomosis of sural nerve and local nerve was done. Results All flaps survived completely without vascular problems. The donor site and wound healed by first intention. All the patients were followed up 6-15 months. The appearance of flap was satisfactory. The texture and color of flaps in all cases were good. There was no pigmentation and contraction. The 2-PD of flap was 7 -12 mm. Conclusion It is an easy and simple therapy to cover wound area after the lateral approach for calcaneal fractures, which can repair the defect and with good function.