腓浅神经营养血管皮瓣修复小腿、踝、足大面积软组织缺损疗效观察

目的探讨腓浅神经营养血管皮瓣修复小腿胫前、踝周、足近端大面积软组织缺损的临床效果。方法采用腓浅神经营养血管皮瓣,修复小腿胫前、踝周、足近端大面积软组织缺损16例18处创面。近、远端蒂最大皮瓣面积分别为7 cm×13 cm和8 cm×15 cm。术中皮瓣周缘扩大切取宽约1 cm筋膜脂肪瓣,从肌膜下游离掀起皮瓣,切取前外侧和外侧2个肌间隔组织,分层缝合深筋膜和皮肤。结果2例皮瓣边缘约2 cm坏死,经换药治愈;其余皮瓣均成活。随访3~18个月,足踝部皮瓣臃肿5例,行皮瓣修整术后行走功能明显改善;痛性神经瘤1例,行神经松解包埋术治愈;与肌腱粘连1例,松解术后足趾运动功能改善。功能优良率81%。患者主观评价满意11例,一般4例,不满意1例。结论腓浅神经营养血管皮瓣血供可靠,切取面积大且方法简单,吻合神经可恢复皮瓣感觉,是一个修复小腿、踝、足部大面积软组织缺损的良好选择。

Curative effect observation of superficial peroneal neurocutaneous flap repairing large area of soft tissue defects of leg, ambi-ankle and foot

Objective It is to explore the clinical effects of the superficial peroneal neurocutaneous flap repairing large area of soft tissue defects around anterior tibial of leg,ambi-ankle and pedalian proximal.Methods Skin flap of super superficial peroneal nutrient vessel was used to repair large area of soft tissue defects around anterior tibial of leg,ambi-ankle,pedalian proximal in 18 wound of 16 cases.The largest area of the flap,proximal and distal pedicle separately,was 7 cm×13 cm and 8 cm×15 cm.In operation,flap circumferential was cut ampliatly 1 cm wide fascia-fat flap and liberation flap from the sarcolemma downstream and cut anterolateral and lateral spacing of two muscle organization,and then sutured deep fascia and skin.Results Two cases had skin edge necrosis about 2 cm and were cured by change of dressing,the rest were all survived.Followed-up of 3-18 months,the flap was bloated in 5 cases, but after revision of skin flap,the walking function with shoes of these patients was improved significantly.One case had got gam-algia neuroma and then was cured by the nerve release and embedding surgery.Tendon adhesion in one case was improved after release.The excellent rate was 81%.According to the subjective evaluation of patients,satisfied in 11 cases,general in 4 cases,not satisfied in 1 case.Conclusion Superficial peroneal neurocutaneous flap has a reliable blood supply and large cut area and can be cut simply,and it can also restore skin feeling with matching nerves,so it is a good selection to repair large area of soft tissue defects of the lower leg,ankle and foot.