跟骨骨折外侧入路术后皮肤坏死缺损的治疗

目的探讨运用逆行腓肠神经营养血管皮瓣,治疗跟骨骨折外侧入路术后皮肤坏死缺损的临床疗效。方法2009年9月至2011年12月,应用逆行腓肠神经营养血管皮瓣,修复跟骨骨折外侧入路术后皮肤坏死缺损24例。缺损大小:3.0 cm×1.5 cm～5.0 cm×2.5 cm,皮瓣切取大小:4.0 cm×3.0 cm～6.0 cm×4.0 cm,术中腓肠神经与受区皮神经吻合以重建感觉功能。结果24例皮瓣全部成活,受区创口Ⅰ期愈合,皮瓣供区切口Ⅰ期愈合。皮瓣术后未出现明显肿胀及血管危象等。术后随访6～15个月,皮瓣外形恢复满意,无明显色素沉着及瘢痕挛缩,无窦道及皮肤溃疡形成,皮瓣两点辨别觉达7～12 mm。结论逆行腓肠神经营养血管皮瓣是跟骨骨折外侧入路术后,皮肤坏死缺损较为理想的治疗方法。

Management of Soft-tissue Defect after the Surgery for Calcaneal Fractures with Lateral Approach

Objective To investigate the efficacy of retrograde sural neurovascular flap in the repair of soft-tissue defect after the surgery for calcaneal fractures with lateral approach.Methods From September 2009 to December 2011,24 patients with soft-tissue defect after the surgery for calcaneal fractures with lateral approach were treated with retrograde sural neurovascular flap.The tissue defects ranged from 3.0 cm × 1.5 cm to 5.0 cm × 2.5 cm and were repaired with retrograde sural neurovascular flaps ranged from 4.0 cm × 3.0 cm to 6.0 cm × 4.0 cm in size.Sural nerve and local cutaneous nerve were anastomosed was done to reconstruct cutaneous sensation.Results All flaps survived completely without vascular problems.The donor site and wound were healed by first intention.All the patients were followed up for 6 to 15 months.The flap appearance was satisfactory.No pigmentation and contraction were observed.The two-point discrimination of the flap was 7-12 mm.Conclusion Using retrograde sural neurovascular flap is an ideal method in repairing the soft-tissue defect after the surgery for calcaneal fractures with lateral approach.