腓动脉穿支蒂腓肠神经营养血管皮瓣修复足踝部软组织缺损与骨髓炎创面

目的 探讨腓动脉穿支腓肠神经营养血管逆行岛状皮瓣修复足踝部创面的临床疗效.方法 采用腓动脉穿支腓肠神经营养血管逆行岛状皮瓣修复足踝部创面26例,创面缺损范围5 cm×3.5 cm~18 cm×10 cm,皮瓣切取面积6.0 cm×4 cm～18 cm×12 cm.结果 26例均得到随访,时间3～12月.患者皮瓣均存活.术后发生皮瓣血管危象2例,予拆除缝线、高压氧治疗好转;皮瓣边缘部分坏死2例,供区植皮坏死1例、感染2例,均经换药治愈.皮瓣外观及功能满意.结论 腓动脉穿支腓肠神经营养血管逆行岛状皮瓣血供可靠,损伤小,不需要显微外科技术,是修复足踝部软组织缺损的较理想皮瓣.

Repair of soft tissue defect and osteomyelitis wound in the ankle and foot with peroneal perforator-based sural neurofasciocutaneous flap

Objective To study the clinical effects for reconstruction the soft tissue defect and osteomyelitis wound in the ankle and foot with sural neurocutaneous vascular flap pedicled on the perforating branch of peroneal artery.Methods 26 patients with soft tissue defect in the heel and foot were treated with sural neurocutaneous vascular flap.The size of soft tissue defect was from 5 cm×3.5 cm to 18cm×10cm,and the size of obtained flaps were from 6.0 cm×4 cm to 18 cm×12 cm.Results All flaps survived through the postoperative follow-up(range from 3 to 12 months).Vascular crisis occurred in 2 patients and obtained improvement after suture release and hyperbaric oxygen therapy.The margin necrosis of flap occurred in 2 patients,wound infection occurred in 2 patients and donor skin grafts necrosis in one.All wound healed after dressing change.The texture and function of flaps were satisfactory.Conclusions The sural neurocutaneous vascular flap pedicled on the perforating branch of peroneal artery is ideal flap for reconstruction the defect in the ankle and foot for reliable blood supply,less invasive and unstricted microsurgical technique.