腓动脉穿支远端蒂保留腓肠神经的筋膜皮瓣临床应用

目的:探讨以腓动脉穿支为蒂的腓肠神经筋膜皮瓣逆行修复足踝部皮肤软组织缺损的临床疗效.方法:临床应用该皮瓣修复足踝部皮肤软组织缺损创面18例,其中保留腓肠神经主干3例,腓肠外侧皮神经l例.结果:18例皮瓣面积9 cm×6cm～18 cm×10 cm.最远修复达足中部皮肤缺损创面.17例随访8个月～27个月.有3例皮瓣远端坏死2.5 cm×2.5 cm～1.7 cm×3 cm游离植皮修复.6例水疱经换药后其余完全成活.足底承重受压后未见异常.10例患者诉外踝及足背外侧皮肤感觉不同程度缺失.结论:腓动脉穿支远端蒂腓肠神经筋膜皮瓣血供可靠,转位更灵活方便是修复足踝部软组织刨面的较好方法.如能实现保留腓肠神经对足背外侧皮肤感觉可有积极意义.

Clinical application of peroneal artery perforator-based sural neurofasciomyocutaneous flap

Objective: To explore clinical effects of peroneal artery perforator-based sural neurofasciomyocutaneous flap on repairing of soft tissue defect in the foot and ankle region. Methods: Pcroneal artery perforator-based sural neurofasciomyocutanoous flap was transferred to repair defected skin and soft tissue in the foot and ankle regions (18 cases). Among them,main trunk of renal nerve and lateral sural cutaneous nerve were kept in 3 cases and 1 case respectively. Results: The range of the flap area was about 9 cm×6cm to 18 cm×10 cm. The distal extension of the flap reached the middle third of the foot. The following up from 8 to 27 months proved that,distal necrosis with the area of 2.5 cm×2.5 cm～1.7 cm×3 cm appeared in 3 cases,which were repaired adopting dermoplasty; water blister appeared in 6 cases and were treated with the change of dressing; anesthesia of lateral ankle and lateral dorsum pedis appeared in 10 cases. Conclusions:Distally peroneal perfora-tor-based sural neurofasciomyocutaneous flap is a reliable,versatile and simple method for foot and ankle coverage,for it has reliable blood supply and convenient transposition approach. In addition,is is more valuable for keeping skin sensation of lateral dorsum pedis by preserving sural nerve.