近踝足部肌腱与骨裸露创面显微外科修复方法的分析

目的评价近踝足部肌腱与骨外露创面修复的简单实用手术方法。方法总结自1990年1月～2002年1月应用13种显微外科皮瓣修复治疗128例近踝足部肌腱与骨外露创面病人,取得良好效果。手术时间:急诊一期修复53例,亚急诊修复28例,晚期修复47例。结果吻合皮瓣静脉修复皮肤逆行撕脱伤26例,完全成活19例,7例部分坏死;游离皮瓣移植19例,13例完全成活,皮瓣坏死3例,皮瓣部分坏死并感染3例;带蒂皮瓣转移83例,其中带腓肠神经营养血管皮瓣58例,该组所有皮瓣无1例完全坏死,5例术后出现静脉回流障碍,松解蒂部血运恢复,4例皮缘坏死,经换药愈合;其余带蒂皮瓣25例,成活21例,部分皮缘坏死3例,感染完全坏死1例。结论带腓肠神经营养血管皮瓣,切取简单,不牺牲知名的血管,对供区侧肢体供血影响小,设计灵活,能为磨擦受压创面提供良好的覆盖,基本能够满足近踝足部肌腱与骨外露创面修复需要。

Analysis of microsurgical repair of deep wounds of the foot near the ankle joint

Objective To evaluate simple and practical methods to repair deep wounds in the foot near the ankle joint.Methods 128cases of deep wounds near ankle jo int with exposed bone and tendons fro mJan 1990to Jan 2002were reviewed .Altogether 13types of microsurgical flaps were applied in these cases and obtained satisfactory results.Timing of sur gery:53cases of primary repair,28c ases of secondary repair,47cases of delayed repair.Results26cases of reverse skin avultion were repaired by venous anastomosis in a valsed flaps,of which19survived completely,and 7underg one partial necrosis.There were 19f ree tissue flap grafts in which 13sur vived,3failed and 3undergone partial necrosis and infection.All pedicle tissue flap grafts amounted to 83cases wi th only3partial necrosis in 58cases of sura l nerve flaps graft,and 1total necro sis in 25other types of flap grafts.Con-clusion Sural nerve flaps graft is a reliable method to repair deep wounds with exp osed bone and tendons near the ankle joint.It is easy to perform with excellent abrasion resistance and little effect on the donor limb.