改良隐神经腓肠神经营养血管逆行皮瓣修复足远端软组织缺损

目的探讨应用改良隐神经、腓肠神经营养血管逆行皮瓣修复足远端软组织缺损的临床效果。方法应用隐神经、腓肠神经营养血管逆行皮瓣，并在其下端再设计一个底边与之相连的辅助皮瓣，用以覆盖较长距离的静脉一神经筋膜蒂转位后外露创面，修复踝足远端软组织缺损14例，皮瓣最大面积30cm×14cm，最小24cm×14cm，皮瓣最上端可切取至胴窝下缘，旋转点在外踝上5-6cm。结果皮瓣全部成活，术后有1例皮瓣远端部分皮肤坏死，经换药后用中厚皮片植皮愈合。所有病例均经6个月至2年以上随访，患肢正常步态行走，皮瓣耐磨，有痛觉。结论改良隐神经、腓肠神经营养血管逆行皮瓣皮肤质量较好，不臃肿，皮瓣切取范围明显大于传统隐神经、腓肠神经皮支营养血管蒂逆行岛状皮瓣，皮瓣上端可达胭窝附近，能很好地修复较长距离的足底、足背及足趾皮肤软组织缺损，且不牺牲主干血管，是修复足远端较大面积皮瓣缺损的理想供区。

Repair of Soft Tissue Defect in Distal End of the Foot with Modified Reversal Vascular Flap of Sural Nerve

Objective To summarize the clinical effect of modified reversal flap of sural nerve vascular flap in repairing soft tissue defect on distal end of the foot. Methods 14 cases of soft tissue defects in ankle and foot were treated with reversal neuro-vascular flap, the size of flaps were 24 cm × 14 cm to 30 cm × 14 cm, the range was up to the lower region of popliteal fossa, rotating point of flap could be reached at 1 cm to above the malleolar. Results All cases of the flap survived. The distal skin necrosis occurred in one flap, but healing occurred after debridement and skin graft. The period of follow ranged from 6 to 24 months. Normal gait was obtained. The flaps were sensible and wear-resist. Conclusion Sural neurovascular flap has preferable skin quality and large donor area without overstaff of major blood vessel. It could be used for repairing the ankle and foot with large soft tissue defect.