小腿皮神经营养血管逆行岛状皮瓣修复踝周创面_临床医学论文.docVIP

小腿皮神经营养血管逆行岛状皮瓣修复踝周创面_临床医学论文 小腿皮神经营养血管逆行岛状皮瓣修复踝周创面_临床医学论文 【摘要】 目的 探讨小腿皮神经营养血管逆行岛状皮瓣修复踝周创面的方法。方法 2006年3月至2008年2月，对13 例踝周皮肤软组织缺损创面应用小腿皮神经营养血管逆行岛状皮瓣进行修复，其中隐神经营养血管逆行岛状皮瓣3 例，腓肠神经营养血管逆行岛状皮瓣10 例。皮瓣切取面积为5.0 cm×6.0 cm～10.5 cm×8.0 cm。结果 术后13 例皮瓣，11 例全部成活；1 例远端部分坏死，经换药后痊愈；1 例大部分坏死，患者拒绝再手术。随访5～15个月，皮瓣质地柔软、弹性好，外形满意，颜色接近正常，踝关节活动正常，患者对皮瓣外形及功能满意。供区植皮全部成活，外形满意。结论 小腿皮神经营养血管逆行岛状皮瓣是修复踝周皮肤软组织缺损创面的一种理想手术方法。 【关键词】 皮肤缺损 皮瓣修复 隐神经 腓肠神经 治疗结果 Abstract：Objective To observe the clinical effect of the transplantation of retrograde island vascular pedicle skin flaps of lower leg cutaneous nerve nutrient vessel for the repaire of the skin and soft tissue defects on ankle.Methods From March 2006 to February 2008，13 cases with skin and soft tissue defects on ankle were reconstructed with retrograde island vascular pedicle skin flaps of lower leg cutaneous nerve nutrient vessel.Among of these，3 cases were repaired with the flaps of saphenous nerve nutrient vessel，10 cases were sural nerve nutrient vessel，the size of the skin flaps were 5.0 cm×6.0 cm～10.5 cm×8.0 cm.Results The flaps survived completely after operation in 11 cases，one flap were marginal necrosis，rerovered after change dressings，one necrosis largely，but no operated again.Followed up from 5 months to 15months，all flaps survived，the appearances，extures and functions of the transplanted flaps were approached to normal skin，the functions of the ankles were good.Conclusion The transplantation of retrograde island vascular pedicle skin flaps of lower leg cutaneous nerve nutrient vessel is an effective method to repair the skin and soft tissue defects on ankle. Key words：skin defect；skin flaps repaired；saphenous nerve；sural nerve；clinical effect 足踝部由于局部软组织少，血运差，在外伤后常出现皮肤缺损或坏死，造成深部组织外露，需皮瓣修复，临床上处理较为棘手。2006年3月至2008年2月，我们采用隐神经、腓肠神经营养血管逆行岛状皮瓣修复踝周创面，效果良好，现报道如下。 1 资料与方法 1.1 一般资料 本组13 例，男10 例，女3 例；年龄20～65 岁，平均28 岁。创面部位：内踝2 例，外踝6 例，踝前2 例，后踝3 例。致伤原因：外伤直接致皮肤缺损11 例，外伤术后皮肤坏死2 例。合并骨折3 例，肌腱缺损1 例。采用隐神经sup2;大隐静脉营养血管逆行岛状皮瓣3 例，腓肠神经sup2;小隐静脉营养血管逆行岛状皮瓣10 例。皮