摘要
目的探讨与总结逆行腓肠神经营养血管皮瓣修复跟腱断裂修补术后跟腱外露的可行性与效果。方法回顾性分析2016年5月至2019年2月于中山大学孙逸仙纪念医院整形外科采用逆行腓肠神经营养血管皮瓣修复跟腱断裂术后跟腱外露患者的临床资料。硬膜外麻醉下,对坏死的皮肤及软组织彻底清除,对跟腱不选择彻底清创,仅清除液化坏死的跟腱表面,且保留之前跟腱手术缝线,清创后采用逆行腓肠神经营养皮瓣覆盖创面。术后随访观察皮瓣血运及外形情况、足部感觉及踝关节功能。结果共纳入7例患者,男4例,女3例,年龄24~69岁,平均45.7岁。跟腱外露处的皮肤软组织缺损面积大小约2.0 cm×5.0 cm~5.0 cm×7.0 cm,皮瓣面积约4.0 cm×7.0 cm~6.5 cm×9.0 cm。7例患者皮瓣供区伤口均能一期闭合。除1例术后10 d发现皮瓣远端约1 cm血运欠佳,后期经换药愈合外,其余患者转移的皮瓣均血运良好,全部供区及缺损区伤口均愈合良好。全部患者随访10~14个月,皮瓣色泽及质地良好,无明显臃肿,术区瘢痕较轻,足跟活动良好,除4例患者足外侧仍有轻度麻木感,其余患者无感觉异常。Kofoed踝关节评分为78~97分,平均88.3分,优6例,良1例。结论腓肠神经营养血管皮瓣邻近跟腱外露缺损区,虽然跟腱断裂开放性修补术后对跟腱区域周围的皮肤软组织及其血运有一定的影响,但仍可以形成蒂部稍高的逆行带蒂皮瓣转移修复跟腱外露。皮瓣供区能直接缝合,具有皮瓣切取简单、创伤小、效果良好等优点。
Objective To explore and summarize the feasibility and effect of repairing Achilles tendon exposure after repair of Achilles tendon rupture with retrograde sural neurovascular flap.Methods The clinical data of patients with Achilles tendon exposure after repair of Achilles tendon rupture admitted to the Department of Plastic Surgery,Sun Yat-sen Memorial Hospital of Sun Yat-sen University from May 2016 to February 2019 were analyzed retrospectively.Under epidural anesthesia,the necrotic skin and soft tissue were removed entirely,and only the liquefied and necrotic surface of the Achilles tendon was removed.The previous surgical suture of the Achilles tendon was retained.After debridement,the wound surface was covered with a retrograde sural nerve flap.The blood supply and shape of the flap,foot sensation,and ankle function were observed after the operation.Results The present study included seven patients(four males and three females,aged from 24 to 69 years old,with an average of 45.7 years old).The size of the skin and soft tissue defect at the exposed Achilles tendon was about 2.0 cm×5.0 cm-5.0 cm×7.0 cm,and the area of the flap was about 4.0 cm×7.0 cm-6.5 cm×9.0 cm.The wounds in the flap donor site of seven patients in this group were closed directly,while one patient whose blood supply of about distal 1 cm of the flap was unsatisfactory ten days after the operation.The patient received a dressing change for 21 days and the wound healed with scar.The other flaps transferred from other patients had a good blood supply,and all wounds in the flap donor site and the defect site healed well.All patients were followed up for 10 to 14 months.The color and texture of the flap were good without obvious bloating.The scar in the operation area was mild,and the heel movement was good.Mild numbness was still felt in the lateral part of the foot in four patients,but no paresthesia was noticed in other patients.The Kofoed ankle score was 78-97,with an average score of 88.3.There were six excellent cases and one good case.Conclusions The sural neurovascular flap is adjacent to the defect area of Achilles tendon exposure.Although the open repair of Achilles tendon rupture has a certain influence on the skin soft tissue and blood circulation around the Achilles tendon area,it can still form a retrograde sural neurovascular flap with a slightly higher pedicle to repair the Achilles tendon exposure.The donor site can be closed directly with minor trauma.The technique is simple and effective as well.
作者
刘蒙
石芬
梁伟强
张剑
苏正
张金明
Liu Meng;Shi Fen;Liang Weiqiang;Zhang Jian;Su Zheng;Zhang Jinming(Department of Plastic and Reconstructive Surgery,Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University,Guangzhou 510120,China)
出处
《中华整形外科杂志》
CSCD
2021年第9期1026-1030,共5页
Chinese Journal of Plastic Surgery
关键词
腓肠神经
小隐静脉
外科皮瓣
皮肤软组织缺损
跟腱断裂
Sural nerve
Small saphenous vein
Surgical flap
Skin soft tissue defect
Achilles tendon rupture
