远端蒂腓肠神经营养血管肌皮瓣的临床应用

目的报道应用远端蒂腓肠神经营养血管肌皮瓣修复填充小腿下段及足踝部创伤性软组织缺损、骨髓炎创腔的临床效果。方法以远端蒂腓肠神经营养血管肌皮瓣修复小腿下段及足踝部因创伤致组织缺损、骨髓炎22例,皮瓣面积最大17 cm×15 cm,最小10 cm×8 cm,肌瓣最大为10．0 cm×7．0 cm×2．0 cm,最小为6．0 cm×5．0 cm×1．0 cm。结果修复小腿下段16例皆获成功,伤口Ⅰ期愈合。修复足踝部6例,皮瓣边缘坏死3例,换药治愈。肌皮瓣坏死1/4,行植皮者1例。肌皮瓣坏死1/3行邻近筋膜皮瓣治愈1例。结论应用远端蒂腓肠神经营养血管肌皮瓣修复小腿下段及足踝部创伤性软组织缺损、骨髓炎创腔是有效可行的,但对携带的肌瓣究竟切取多大面积是安全的以及肌瓣的血运机制等问题仍有待进一步研究。

Clinical application of distally based sural fasciomusculocutaneous flap

Objective To report the clinical effects of distally based sural fasciomusculocutaneous flap for reconstructing the soft tissue defects and cavity of osteomyelitis in the distal lower-limb,ankle and heel.Methods Curative effects of 22 patients with soft tissue defects in the distal lower-limb and ankle and heel undergoing reconstruction utilizing distally based fascionmusculocutaneous flap,were summarized and an- alysed.Results All of 16 patients with soft tissue defects in distal lower-limb were cured successfully,inci- sion healed primarily.Of 6 patients with ankle and heel soft tissue defects,three flaps had necrosis of the dis- tal edge,and healed after dressing change;one musculocutaneous flap underwent one forth necrosis and cured by dermoplasty;one had one third necrosis and cured by reconstruction of nearby fasciocutaneous flap.Con- clusion It is effective and feasible that utilizing distally based sural fasciomusculocutaneous flaps reconstruct traumatic soft tissue defects and osteomyelitis cavities of distal lower-limb and ankle and heel.But some ques- tions are necessary to further investigate,such as the biggest safe size and the mechanism of reverse blood sup- plying of the carried gastrocnemius muscle.