腓肠神经营养皮瓣移植修复足踝软组织缺损中小隐静脉干的处理

背景:在临床上应用和报道中小隐静脉在皮瓣中所起的作用及血管近端蒂如何处理意见不尽一致.目的:应用腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部软组织缺损,观察分析不同方式处理小隐静脉对皮瓣成活的影响.设计、时间及地点:病例对比观察,于1998-03/2007-04在解放军广州军区广州总医院完成.对象:将56例足背、足跟及踝部软组织缺损的患者按手术方式分为2组,结扎小隐静脉近端蒂皮瓣组38例,小隐静脉近端与受区大隐静脉或其属支吻合组18例.方法:应用腓肠神经营养血管皮瓣逆行移植修复时,皮瓣切取面积为3.5 cm×4.0 cm～4.0 cm×4.5 cm的病例35例;皮瓣切取面积为4.0cm×4.5 cm～10.0 cm×12.0 cm的病例21例.主要观察指标:不同切取面积及移植方式的皮瓣成活效果.结果:1]皮瓣切取面积为(4.0×4.5)cm～(10.0×12.0)cm时,移植后未出现静脉危象:皮瓣切取面积为(3.5×4.0)cm～(4.0×4.5)cm时,结扎小隐静脉近端的患者中5例出现术后静脉危象.2]在皮瓣切取面积为(3.5×4.0)cm-(4.0×4.5)cm时,移植后小隐静脉近端与受区大隐静脉或其属支吻合皮瓣出现坏死的概率低于结扎小隐静脉近端蒂皮瓣(P=0.017 67).结论:切取皮瓣面积小于(4.0×4.5)cm时,应将小隐静脉近端与受区大隐静脉或其属支吻合.小隐静脉在皮瓣中并非过路浅静脉.对皮瓣有营养作用.

Disposal of the small saphenous vein trunks during sural neurocutaneous island flap transplantation for repairing soft tissue defects of the foot and ankle

BACKGROUND: Scholars disagree with each other about the small saphenous vein effects on skin flap and how to dispose vascular proximal pedicles.OBJECTIVE: To analyze effects of different methods of the small saphenous vein disposal on flap survival using sural neurocutaneous island flap retrograde metastasis for repairing defects of soft tissue of instep, heelstick and ankle.DESIGN, TIME AND SETTING: The case control observation experiment was performed at the General Hospital of Guangzhou Military Area Command of Chinese PLA from March 1998 to April 2007.PARTICIPANTS: A total of 56 patients with defects of soft tissue of instep, heelstick and ankle were divided into 2 groups,small sapbenous vein deligation in proximal pedicle flap group (group A) (n=38), and proximal small saphenous vein and great saphenous vein or tributaries at recipient site anastomosis flap group (group B) (n=18).METHODS: During sural neurocutaneous island flap retrograde metastasis for repair,(3.5×4.0)cm-(4.0×4.5) cm flap was obtained in 35 cases, and (4.0×4.5) cm -(10.0×12.0) cm in 21 cases.MAIN OUTCOME MEASURES: Outcome of flap survival at different incision area and implanted methods.RESULTS: No vein articulo occurred in 21 cases, which flap areas were (4.0×4.5) cm -(10.0×12.0) cm. Five of 35 cases which flap areas were (3.5×4.0) cm -(4.0×4.5) cm developed vein articulo.The necrotic rate of flaps in group B was significantly lower compared to the group A (P=0.017 67).CONCLUSION: When the area of skin flap is smaller than (4.0×4.5) cm, the proximal end of the small saphenous vein should be anastomosed with the great saphenous vein or tributaries connecting with the great saphenous vein at recipient site.The small saphenous vein is not a superficial vein, which only cross the skin flap, but it has trophic action on the skin flap.