摘要
目的探讨应用不同类型皮瓣修复足踝部软组织缺损的临床效果。方法 2007年5月—2015年12月武警广西总队医院应用4种皮瓣修复足踝部软组织缺损患者共48例。其中男性31例,女性17例;年龄5～62岁,平均33.5岁。致伤原因:道路交通伤24例,重物压伤15例,自行车轮辐绞伤5例,摩托车排气管烫伤4例;创面缺损面积:3.0cm×5.0cm～13.0cm×28.0cm,切取皮瓣面积4.0cm×7.0cm～15.0cm×32.0cm。其中应用腓肠神经营养血管皮瓣18例,胫后动脉穿支皮瓣12例,腓动脉外踝上穿支皮瓣10例,股前外侧皮瓣修复8例。观察患者感觉功能情况。结果 48例获随访10～35个月,平均22.5个月。39例皮瓣完全成活;8例皮瓣远端坏死,经换药愈合;1例皮瓣发生坏死,二次手术植皮。5例皮瓣臃肿,二期行修整术。6例吻合神经的皮瓣患者术后4～6个月感觉功能均完全恢复,其余42例患者感觉功能部分恢复。3例皮瓣修复术后足底局部溃疡形成,其余45例皮瓣质地柔软,踝关节功能恢复满意。结论腓肠神经营养血管皮瓣、胫后动脉穿支皮瓣、腓动脉外踝上穿支皮瓣及股前外侧皮瓣修复足踝部软组织缺损疗效肯定,各具优缺点。应根据足踝部软组织缺损部位、面积不同个性化选择合适术式,提高皮瓣存活率,恢复患肢功能。
Objective To investigate the clinical effect of repairing soft tissue defect in foot and ankle with various kinds of flaps. Methods Four kinds of flaps were used to repair soft tissue defect in foot and ankle in Guangxi General Hospital of Chinese People's Armed Police Force from May 2007 to Dec. 2015. There were 31 males and 17 females, with an average age of 33.5 years (range, 5-62 years). There were 24 cases of traffic accidents, 15cases of crush injuries by heavy weight, 5 cases of bicycle-related injuries, and 4 cases of burning injuries by motorcycle vent-pipe. The area of defects ranged from 3.0cm×5.0 cm to 13.0 cm×28.0cm, and the area of flaps ranged from 4.0cm×7.0cm to 15.0 cm×32.0cm. The 48 flaps consisted of 18 sural neurovascular flaps, 12 posterior tibial artery perforator flaps,10 radial iliac artery perforator flaps, and 8 anterolateral thigh flaps. The sensibility of all flaps was observed. ResultsForty-eight cases were all followed up for 10 to 35 months(average,22.5 months). Thirty-nine flaps survived well, the distal part of 8 flaps suffered putrescence and healed by means of changing dressings, 1 flap suffered necrosis and was repaired with skin graft, and 5 flaps became fat and clumsy and received secondary repair. Six patients with anastomotic flaps recovered completely at 4 to 6 months after operation, and the rest of the patients recovered part of sensory function. Three patients developed localized ulceration after flap repair, and the other flaps were soft and obtained satisfactory ankle function. ConclusionThe sural neurovascular flap, the posterior tibial artery perforator flap, the radial iliac artery perforator flap and the anterolateral thigh flap are effective in repairing the soft tissue defects of the foot and ankle. Each kind of flap has its own advantages and disadvantages. The appropriate surgical procedure should be selected according to the soft tissue defect site and area of the ankle and foot to improve the survival rate of the flap and restore the function of the affected limb.
作者
农明善
陈凯宁
罗柳宁
黄耿
杨幸
王鹤云
NONG Ming-shan;CHEN Kai-ning;LUO Liu-ning;HUANG Geng;YANG Xing;WANG He-yun(Department of Orthopaedics, Guangxi General Hospital of Chinese People s Armed Police Force,Nanning530003,China)
出处
《创伤外科杂志》
2019年第4期244-247,共4页
Journal of Traumatic Surgery
关键词
软组织缺损
足踝部
皮瓣
修复
soft tissue defect
foot and ankle
skin flap
repair
