摘要
目的介绍改良逆行小腿内侧皮瓣在修复同侧及对侧足踝及小腿软组织缺损中的应用经验。方法 2008年8月至2011年8月,收治足踝及小腿下段皮肤软组织缺损17例,其中足跟溃疡缺损1例,足踝软组织缺损7例,小腿下段软组织缺损9例。皮肤软组织缺损面积3.0cm×2.0cm～12.0cm×8.0cm。最远达第一跖趾关节。切取皮瓣面积3.5 cm×5.0cm～28.0cm×12.0cm。修复同侧13例,交腿修复对侧4例。结果 17例术后皮瓣全部存活,仅1例交腿皮瓣术后皮瓣远端少量坏死,换药后愈合。全部病例均获得随访,随访时间6～12个月。皮瓣外形色泽及质地良好,3例略显臃肿,无溃疡复发,皮瓣均获得保护性感觉。足底溃疡修复后3个月开始负重,负重行走及耐磨正常,1年内未见溃疡复发。全部病例踝关节伸屈功能良好。结论含胫后动脉内踝上皮支、大隐静脉及隐神经的改良逆行小腿内侧皮瓣由于综合了两种传统皮瓣血供,风险明显降低,存活率高。同时增大了切取范围,可修复较大的软组织缺损。既可修复同侧亦可交腿修复对侧。无需术前多普勒血管探查,静脉回流充分,不损伤下肢主要血管。具有很好的应用前景,尤其适合基层。
Objective To introduce the application experience of repairing homolateral and contralateral soft tissue de feets in foot, ankle and cnemis by using improved converse calf medial flaps. Methods From August 2008 to August 2011, 17 cases of skin and soft tissue defects in foot, ankle and calf were treated. There was one case of calcar pedis soft tissue defects, 7 cases of foot and ankle soft tissue defects, and 9 cases of distal calf soft tissue defects. The biggest area of the skin and soft tissue defect was 12 crux 8 cm, and the smallest 3 cmX 2 cm, and the furthest went to the 1st metatarsophatangeal joint. The size of the flaps ranged from 3.5 cm× 5.0 cm to 28 cm×12 cm. Ipsilateral defects were repaired in 13 cases, and cross leg flaps were used to repair contralateral defects in 4 cases. Results Seventeen flaps survived except 1 cross-leg flap which had little necrosis in the bottom, and it cicatrized after replacing dressing. All patients were followed up from 6 to 12 months. Both the quality and appearance of the flaps were satisfactory, 3 flaps were a little overstaffed, and there was no ulceration recrudes- cence. All flaps had protected sense. The patients could walk after 3 months when thenar ulceration repairing, both walking and abradability were normal, and no ulceration recrudescence occurred after l year. The flexion and extension functions of the ankle were satisfactory in all patients. Conclusion The improved converse calf medial flap within posterior tibial artery perfora- tor, great saphena venae and nervi saphenus can not only reduce the risk, but also increase the survival rate and the flap range. It can repair the bigger soft tissue defects, and can repair ipsilateral defects and also contralateral defects with crossqeg flaps. The vessels don＇t need exploration with Doppler, and the vein circumfluence is sufficient. The improved converse calf medial flap doesn＇t injure the main vessels of the leg.
出处
《骨科》
CAS
2013年第1期22-24,共3页
ORTHOPAEDICS
关键词
腿损伤
外科皮瓣
修复外科手术
软组织损伤
Leg Injuries
Surgical flap
Reconstructive Surgical Procedures
Soft tissue injuies
