腓肠神经营养血管逆行皮瓣修复小腿下段及足部组织缺损

目的 了解腓肠神经营养血管逆行皮瓣修复小腿下段及足部组织缺损的临床效果.方法 1997年6月-2007年8月,笔者对56例小腿下段及足部组织缺损患者(小腿下段软组织缺损10例;创面感染,胫、腓骨骨折外露,骨坏死38例;足部组织缺损、贴骨瘢痕、骨髓炎8例)的创面,采用腓动脉穿支供血的腓肠神经营养血管逆行岛状皮瓣(46例)或肌皮瓣(10例)进行修复.皮瓣面积5 cm ×4 cm～22 cm × 16 cm,供瓣区直接拉拢缝合或行游离植皮封闭.结果 其中55例患者术后皮瓣完全成活,创面愈合.随访3～6个月无任何并发症,皮瓣质地优良,外观满意,患者行走正常,但皮瓣感觉功能恢复欠佳.1例患者治疗时为保留下肢长度,未将部分坏死胫骨去除,术后1个月皮肤破溃,经再次手术后创面愈合.结论 腓肠神经营养血管逆行岛状皮瓣或肌皮瓣移植术,是修复小腿下段及足部软组织缺损的较佳方法.

Repair of tissue defect of lower leg and toot with reverse islaud skin flaps with sural nerve and blood supplying vessels

Objective To observe the clinical effect of reverse island skin flaps with sural nerve and blood supplying vessels on repair of tissue defect of lower leg and foot. Methods Fifty-six patients with lower leg and foot tissue defects were hospitalized from June 1997 to August 2007. Among them, 10 patients suffered from soft tissue defect of lower leg; 38 patients suffered from wound infection, exposure of fracture of tibia and fibula, and osteonecrosis; 8 patients suffered from heelstick tissue defect, bone adhering sear, and osteomyelitis. The defects were repaired with sural nerve and blood vessel nourished reverse island skin flaps (46 cases) and myocutaneous flaps(10 cases). The size of flaps ranged from 5 cm×4 cm to 22 cm×16 cm. Flap donor sites were closed by direct suture or free skin grafting. Results Flaps in 55 cases sur-vived. Patients were followed up 3-6 months, there was no complication, and they were healed with satisfac-tory texture and appearance. The patients could walk normally, but with unsatisfactory sensory recovery. In one patient, the flap was broken and ulcerated 1 month after operation on account of leaving behind necrotic tibia. It was healed after second operation. Conclusions Sural nerve and blood vessel nourished reverse island skin flap or myocutaneous flap transplantation is an effective treatment for repair of soft tissue defect of lower leg and foot.