摘要
目的探讨应用腓动脉穿支蒂腓肠神经营养血管皮瓣修复下肢皮肤软组织缺损的手术方法及临床效果。方法2009年1月-2012年3月，笔者单位收治26例小腿下段及足部皮肤软组织缺损患者，其中车祸伤致小腿下段肌腱或骨外露9例，高压电击伤致足踝部皮肤坏死4例，小腿及足部慢性溃疡8例，足底压疮5例。彻底清创后，皮肤软组织缺损范围为11cm×5cm～18cm×13cm。根据缺损部位及大小设计切取腓动脉穿支蒂腓肠神经营养血管皮瓣，逆行转移修复皮肤软组织缺损。皮瓣切取面积12cm×6cm～20em×15cm。供瓣区直接拉拢缝合或植皮修复。结果25例皮瓣完全成活，l例皮瓣远端约2Cm×1em的区域坏死，经换药后愈合。随访6-12个月，皮瓣外形和局部感觉良好，无溃疡，行走正常。结论腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作相对简便，血供可靠，蒂部臃肿不明显，能切取蒂部较长，皮瓣可切取面积较大，是修复小腿下段及足部皮肤软组织缺损的较佳方法。
Objective To explore the operative technique and clinical results of using peroneal per- forator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities. Methods From January 2009 to March 2012, 26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized. Among them, 9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer. After debridement, soft tissue defect sizes ranged from 11 cm × 5 cm to 18 cm × 13 cm. According to the position and size of the defects, peroneal perforator-based sural neurofasclocutane- ous flaps were designed and procured to repair the skin and soft tissue defects. The size of flaps ranged from 12 cm×6 cm to 20 cm× 15 cm. Flap donor sites were closed by direct suture or skin grafting. Results Twenty-five flaps survived completely. Only one flap suffered partial margin necrosis in the size of 2 cm × 1 cm, which was healed after dressing change, Patients were followed up for 6 to 12 months. The appear- ance and sensation of flaps were satisfactory; no ulcer occurred ; the movement of lower extremities was nor- mal. Conclusions It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofaseiocutaneous flap, as it possesses reliable blood supply, long and non-bulky pedicle, and sufficient available size. The operation is also easy to perform.
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2013年第5期432-435,共4页
Chinese Journal of Burns
关键词
外科皮瓣
腓肠神经
软组织损伤
Surgical flaps
Sural nerve
Soft tissue injuries
