腓肠神经血皮瓣修复足跟区皮肤软组织缺损.docVIP

腓肠神经血管皮瓣修复足跟区皮肤软组织缺损 　　作者：董忠根,魏建伟　刘立宏,郑,磊,马丙栋　　作者单位：1.中南大学湘雅二医院骨科一病区，湖南 长沙 410011;2.中南大学湘雅医学院株洲临床学院(株洲市一医院)创伤骨科，湖南 株洲 412000 　 【摘要】[目的]探讨远端蒂腓肠神经营养血管皮瓣修复足跟区的特点。[方法]2002年6月～2008年7月行远端蒂腓肠神经营养血管皮瓣修复足跟区皮肤软组织缺损58例，其中创面合并有足跟部空洞形成者10例，创面位于跟底行皮神经吻合13例，皮瓣面积8 cm×4 cm～20 cm×15 cm，皮瓣的切取采用先显露穿支血管后游离皮瓣的方法。[结果]本组58例皮瓣中，46例完全存活，12例远端浅表或部分坏死，经换药、Ⅱ期缝合或植皮后创面愈合。经术后1～34个月随访，皮瓣均外观较满意，感染控制且无复发，无慢性溃疡及压疮形成，行走功能好。[结论]远端蒂腓肠神经营养血管皮瓣修复足跟区创面具有血运丰富，成活面积大，手术简单，成功率高，可重建保护性感觉的优点，大部分足跟区皮肤软组织缺损可用该皮瓣修复。 　　【关键词】 腓肠神经; 外科皮瓣; 足跟区; 软组织缺损; 修复 　　Distally based sural neurofasciocutaneous flap for repairing soft tissue defects in heel∥DONG Zhonggen,WEI Jianwei,LIU Lihong,et al.Department of Orthopaedics,the 2nd Xiangya Hospital,Central South University,Changsha 410011,China 　　Abstract：[Objective]To investigate the characteristics of the distally based sural neurofasciocutaneous flap for repairing soft tissue defects in heel.[Method]From June 2002 to July 2008,58 cases of soft tissae defects in heal were repaired with distally based sural neurofasciocutaneous flaps.Among them,10 cases combined with a dead cavity,13 cases were innervated with the anastomosis of the sural nerve to the cutaneous nerve of recipient site.The size of the flaps ranged from 8 cm×4 cm to 20 cm×15 cm.The perforating barnches of peroneal artery in fascia pedicle were exposed first,and then the flaps were harvested.[Result]Fortysix flaps survived uneventfully.Necrosis took place in the distal part in 12 flaps,and the wounds healed after changing dressing daily,twostage suture or skingrafting.Through 1 to 34 months of followup,all the survival flaps provided good contours.Infection was controlled and no recurrence,ulcer or pressure sore was found.Walk function was good.[Conclusion]Distally based sural neurofasciocutaneous flaps for reparing soft tissue defects have many advantages.It can offer abundant blood supply,large survival size,simple operation,high achievement rate,and reestablishment of protective sensation