负压封闭引流加逆行腓肠神经皮瓣在下肢软组织缺损中应用.docVIP

负压封闭引流加逆行腓肠神经皮瓣在下肢软组织缺损中应用[摘要]目的：总结负压封闭引流治疗结合逆行腓肠神经皮瓣的临床应用经验。方法：回顾2009年至2012年8例小腿下部软组织缺损创面采用负压封闭引流后行逆行腓肠神经皮瓣修复的临床资料。结果：7例皮瓣安全存活，1例皮瓣远端部分坏死，8例无感染发生，皮瓣切取最大面积可达20cm×8cm，最小面积4cm×4cm，可修复小腿中下段、内外踝部、足跟部、足背部创面，效果良好。结论：负压封闭引流加逆行腓肠神经皮瓣修复小腿下部软组织缺损，可有效控制创面感染，手术操作简便，皮瓣成活率高。 [关键词]负压封闭引流；腓肠神经；皮瓣；下肢；软组织缺损 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2013）01-0120-03 Application of combined method of vacuum sealing drainage （VSD） and retrograde sural nerve flap in treating soft Tissue defects of lower limbs ZHANG Sheng-li，ZHANG Jia，WANG Lian-mei，WANG Ya-rong （Department of Burn and Plastic Surgery，The Third People’s Hospital，Datong 037008 Shanxi，China） Abstract： Objective Sum up the experiences of the clinical application of the combined method of vacuum sealing drainage （VSD） and retrograde sural nerve flap. Methods Review the clinical materials about the eight cases on using VSD and then retrograde sural nerve flap repair to treat the soft tissue defect wound surface of lower calf from 2009 to 2012. Results In 7 cases the flaps survive，and in 1 case the distal part of the flap necrotizes. No infection occurs in all eight cases. The maximum incisional area of the flap is 20cm×8cm while the minimum is 4cm×4cm. The flaps can repair the wound surface on the middle and lower parts of the calf， the external and internal malleolus，heel and instep and show good effects. Conclusions Using VSD and retrograde sural nerve flap to repair the soft tissue defect of lower calf can effectively control wound infection， the surgery is easy to operate and the survival rate of flags is high. Key words： Vacuum sealing drainage （VSD）； sural nerve； flap； lower limbers； soft tissue defect 小腿中下段、踝关节部、足部在日常生活中容易受到外界的伤害，由于该区域软组织薄、血运差，外伤或术后极易出现软组织缺损导致骨质、肌腱及钢板的外露，外露组织容易感染，在治疗上有一定困难。笔者2009年1月～2012年1月对8例小腿下部软组织缺损的病例先行创面负压封闭引流，然后应用逆行腓肠神经皮瓣进行修复，取得良好效果，现总结如下。 1 资料和方法 1.1 一般资料：本组患者8例，男性 6例，女性 2例，年龄18～58岁。组织缺损部位：足跟处 1例，足背内踝关节 3例，小腿中下段胫前软组织缺损 4例。8例全部为车祸致下肢骨折，均伴有肌腱、骨质外露和内固定钢板外露；1例曾行局部旋转皮瓣修复失败；皮瓣面积在