以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面的临床研究

目的　探讨以筋膜蒂相连的单穿支双叶游离型股前外侧皮瓣修复肢体创面的临床效果。 方法 自2013年8月至2019年9月，使用以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面24例，其中18例为单个创面，面积14 cm×7 cm ~ 24 cm×14 cm；5例为手或足的两处创面，面积4 cm×4 cm ~ 30 cm×17 cm；1例为左2~5指背侧远端创面，作为两个创面来处理。所有病例设计以筋膜蒂相连的单穿支双叶型皮瓣修复，供区直接缝合。 结果　本组双叶皮瓣均顺利成活，大腿供区均Ⅰ期愈合。随访4 ~ 70个月，皮瓣色泽质地良好，皮瓣温、痛、触觉部分恢复。供区均存留线性瘢痕，1例瘢痕面积较大，但未出现瘢痕挛缩及疼痛等不适，2例患者术后早期出现切口区感觉异常，3月后恢复，无其他严重并发症发生。 结论　应用以筋膜蒂相连的单穿支双叶型股前外侧皮瓣修复四肢创面，可以解决穿支数量不足致双叶皮瓣无法切取的问题，同时减小供区切取宽度，有效地降低损伤。

Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for repairing lower leg and ankle soft-tissue defects

Objective　To evaluate the clinical efficacy of peroneal perforator-plus pedicled sural neurofasciocutaneous flap in the reconstruction of lower leg and ankle soft-tissue defects.　Methods　Clinical data were collected from January 2017 to January 2019. Total 15 cases were involved in this study, all including the lower leg and ankle soft-tissue defects and were treated with the peroneal perforator-plus pedicled sural neurofasciocutaneous flap. The patients involves 11 males and 4 females. Range of age was from 14 to 65 (average 39 years). There were 6 cases of lower leg wound and 9 cases of ankle wound. Repair of wounds was with peroneal perforator-plus pedicled sural neurofasciocutaneous flap. The size of the soft-tissue defects ranged from 9 cm×4 cm to 26 cm×5 cm. The donor area site was sutured directly. If the tension of donor site was large, the skin graft was done to the site. After surgery, patients were taken routine treatment manners of immobilized, intravenous antibiotic, antithrombotic, antivasospasm, antiinflammatory and keep flap site warming. The flap survival and the effect of the reparations of the skin and soft tissue defect were observed during follow- up period.　Results　The flap size ranged from 10 cm×5 cm to 27 cm×7 cm. The patients were followed up for 6 to 22 months, with a mean of 13 months. 14 cases of the flap survived, 1 case with the venous reflux, the distance portion of the flap suffered from necrosis and second time wound debridement done, and the skin graft applied, the repair site healed well. 9 cases of ankle and foot ulcers represented as ankle joint dorsiflexion and plantar flexion slightly limited. 2 cases of tibial open fracture were treated with external fixation, and non-union occurred and changed to internal plate fixation and fracture union. 2 cases affected flap extruded from the wound site and inconvenient for shoeing, and the flap transformed and improved.　Conclusions　The peroneal perforator-plus pedicled sural neurofasciocutaneous flap in the reconstruction of the lower leg and foot defect is a good surgical intervention.