逆行腓肠神经营养血管皮瓣治疗小腿及足踝部软组织缺损.docVIP

逆行腓肠神经营养血管皮瓣治疗小腿及足踝部软组织缺损[摘要]目的：观察应用腓肠神经营养血管皮瓣修复小腿下段及足踝部创伤性软组织缺损的临床效果。方法：以逆行腓肠神经营养血管皮瓣修复小腿下段及足踝部因创伤致软组织缺损187例。皮瓣最大面积14cm×13cm，最小4cm×3cm。结果：修复小腿下段113例皆获成功，伤口1期愈合，11例皮肤边缘坏死，换药治愈，4例坏死面积较大，经换药，邮票植皮且治愈，足及踝部修复54例，伤口1期愈合，5例局部坏死，经换药后获治愈。结论：应用逆行腓肠肌神经营养血管皮瓣可以有效修复小腿及足踝部皮肤缺损，此皮瓣血运丰富，手术操作简便。 [关键词]腓肠神经；皮瓣；软组织缺损移植 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2011）04-0536-03 Reversed sural neurovascular flap for reconstruction of soft-tissue defects in ankle，foot and leg XIAO Jian-lin1,2,LIU Xiong2,LU Ji-ping2,NIU Yong-gang2,DING Shou-yong2,LIAO Qian-de1 (1.Department of Orthipedics,Xiangya Hospital,Central South University,Changsha 410008,Hunan,China；2.The Third Department of Orthipedics PLA 163 Ceutral Hospital, Changsha 410001,Hunan,China) Abstract:Objective To observe the clinical effects of reversed sural neurovascular flap for reconstruction of soft-tissue defects in ankle,foot and leg 187 cases.MethodsUse reversed sural neurovasular flap to reconstract 187 cases of soft-tissue defects in ankle and leg.The range of flap was 4cm×3cm to 14cm×13cm.All were summarized and analysed.ResultsAll of 113 patients with soft tissue defects in leg were cured successifully,incision healed primarly eleven flaps had necrosis and healed after dressing change and four stamp flap transplantation.54 ceses of foot and ankle soft tissue defeots healed,five flaps had necrosis and healed after dressing change.ConclusionIt is effective that utilizing reversed sural neurovascular flap for reconstraction of soft tissue defects in ankle,foot and leg.The blood supply of flap is sufficinent.The manual of operation is simple. Key words:sural nervel;flap;soft tissue defect;transplantation 由于解剖位置的特殊性，小腿和足部易受外伤，外伤后所致的软组织缺损难以修复，导致骨质及肌腱外露，伤口感染,难以愈合，临床治疗比较困难。显微外科技术对医生的要求高，且对设备的要求也高，有一定的风险和失败率，而应用逆行腓肠神经营养血管皮瓣不需吻合血管，成活率高，疗效好，易于广大基层医院普及。我院自2006年3月～2010年9月应用逆行腓肠神经营养血管皮瓣修复小腿下段及足部软组织缺损187例，术后平均数随访6～18个月，患肢软组织缺损修复满意，功能恢复良好，报道如下。 1资料和方法 1.1 临床资料：本组187例，男性，111例，女性，76例，年龄12～78岁，平均年龄46.1岁。损伤原因：车祸伤95例，