优选皮瓣修复足跟部负重区并重建感觉功能

目的探讨足跟部负重区软组织缺损皮瓣修复的适应证及皮瓣的优化选择。方法 2000年1月~2014年3月收治47例足跟部负重区软组织缺损患者,男性29例,女性18例;年龄7~56岁,平均37.8岁。根据足跟部负重区缺损创面大小及位置,采用皮瓣修复,吻合皮神经重建感觉。结果皮瓣均成活,其中1例皮瓣远端1cm表皮坏死,换药后愈合,1例游离皮瓣术后10d暗红,经解痉保暖缓解。随访6个月~11年,皮瓣恢复保护性感觉,未见破溃。结论足跟负重区缺损需要一定厚度组织瓣修复,并重建感觉,应合理选用组织瓣,腓肠神经、隐神经营养血管皮瓣修复足跟部中小创面,游离皮瓣、小腿内侧皮瓣及健侧隐神经皮瓣可用于修复巨大创面。

Optimization of the flaps in repairing tissue defects in heel weight-bearing area and reconstructing their sensory function

Objective To explore the indications in repairing the soft tissue defects of heels weight-bearing area,and the optimization of the flaps.Methods Forty-seven patients with soft tissue defects in heel weight-bear-ing area were repaired.There were 29 males and 18 females,with age ranging from 7 to 56 years(mean,37.8 years) .Different kinds of flaps were applied for repair based on the defect sites and sizes,and the tegmentary nerve was anastomosed for reconstructing their sensory function. Results The flaps survived in all patients. Among them,1 case had superficial necrosis at 1cm distal to the flap, which was healed after several times of dressing change;1 case was found in dark red color on the free flaps,and was relieved by spasmolysis and keeping warm.All patients were followed up for 6 months to 11 years and all flaps received the sensory function without ulceration. Conclusion Repair of defects in heel weight-bearing area requires flaps with a certain thickness and reconstruction of sensory function.And different flaps should be appropriately selected,sural nerve nutritional vessel flap and sa-phenous nerve nutritional vessel flap should be used for repairing small wound,free flap and contralateral medial leg saphenous nerve flap should be used to repair huge wound.