应用4种皮瓣修复小儿足跟部软组织缺损的临床效果

目的探讨应用4种皮瓣修复小儿足跟部软组织缺损的临床效果。方法 2006年8月～2010年9月采用小腿外侧皮瓣、外踝上动脉皮瓣、股前外侧皮瓣和腓肠神经营养皮瓣修复小儿足跟部软组织缺损33例,年龄3～12岁。缺损面积:4cm×3cm～18cm×11cm;8例伴有跟腱缺损。切取皮瓣面积:5cm×4cm～20cm×13cm;小腿外侧逆行岛状皮瓣10例、股前外侧皮瓣9例、腓肠神经营养皮瓣8例、外踝上动脉皮瓣6例。结果 33例经8～19个月随访,皮瓣外形和质地良好,术后皮瓣全部成活。其中2例股前外侧皮瓣发生静脉危象,经重新吻合静脉后皮瓣成活;3例腓肠神经营养皮瓣发生远端边缘坏死,最大1.5cm×1cm,经伤口换药后痊愈。8例合并跟腱缺损者,5例用股前外侧皮瓣和深筋膜(髂胫束)重建后屈踝功能恢复近于正常,3例屈踝肌力减弱,有较明显的跛行。结论小腿外侧皮瓣、外踝上动脉皮瓣和腓肠神经营养皮瓣具有切取简便,损伤小,皮瓣外形和质地良好,是修复小儿足跟部中小面积软组织缺损的较理想方法,而股前外侧皮瓣则是修复小儿足跟部大面积缺损或合并跟腱缺损的有效方法之一。

Clinical effect of 4 types of flap in repairing heel soft tissue defect in children

Objective To investigate the clinical results of 4 types of flaps in repairing heel soft tissue defect in children.Methods From Aug.2006 to Sep.2010,33 children aging 3-12 with heel soft tissue defect were repaired with lateral lower leg flap,lateral malleolar artery flap,anterolateral thigh flap and sural nerve flap.The defects area ranged from 18 cm×11cm to 4 cm×3cm and eight cases were found with Achilles tendon defect.The flaps size ranged from 20 cm×13cm to 5 cm×4cm and lateral lower leg island flap was applied in 10 cases,anterolateral thigh flap in 9 cases,sural nerve flap in 8 cases,lateral artery flap in 6 cases.Results All flaps in the 33 cases were survived.However,venous crisis occurred in anterolateral thigh flap in 2 patients,who were survived after venous re-anastomosis.Distal edge necrosis（maximum 1.5cm×1cm） occurred in sural nerve flaps in 3 patients,who were healed after wound dressing.After 8 to 19 months follow-up,good flap shape and texture were achieved.Among 8 cases of Achilles tendon defects with anterolateral thigh flap and iliotibial tract reconstruction,flexor ankle function was recovered in 5 cases,weakened ankle flexor muscle and remarkable limp were observed in 3 cases.Conclusion Applying lateral lower leg flap,lateral malleolar artery flap and sural nerve flap is a good method to repair small-size heel soft tissue defect in children,with advantages of simple procedure,mini-invasiveness,good flap shape and texture.Meanwhile,applying anterolateral thigh flap is an effective way to repair large-size heel soft tissue defect combined wth achilles tendon defect in children.