腓肠神经延迟皮瓣修复足部软组织缺损的临床效果

doi:10.3877/cma.j.issn.1674-0785.2021.01.004

中华临床医师杂志(电子版) ›› 2021, Vol. 15 ›› Issue (01) : 22 -25. doi: 10.3877/cma.j.issn.1674-0785.2021.01.004

所属专题：文献；

临床研究

腓肠神经延迟皮瓣修复足部软组织缺损的临床效果

张功林¹, 师富贵¹, 王行高¹, 何如祥¹, 胡军¹^,^†(

), 孙萍¹, 龚铁军², 王耀华², 邹永刚²

^1. 730050　兰州，甘肃省兰州市兰州手足外科医院手外科
^2. 734000　甘肃张掖，甘肃省河西学院附属张掖人民医院骨科

收稿日期:2020-08-02 出版日期:2021-01-15
通信作者: 胡军
基金资助:
兰州市科学技术局项目(2018-4-60)

Clinical effect of delayed sural neurocutaneous flap for reconstruction of soft-tissue defect of the foot

Gonglin Zhang¹, Fugui Shi¹, Xinggao Wang¹, Ruxiang He¹, Jun Hu¹^,^†(), Ping Sun¹, Tiejun Gong², Yaohua Wang², Yonggang Zou²

^1. Department of Hand Surgery, Lanzhou Hand and Foot Surgery Hospital, Lanzhou 730050, China
^2. Department of Orthopaedics, Zhangye People's Hospital Affiliated to Hexi College, Zhangye 734000, China

Received:2020-08-02 Published:2021-01-15
Corresponding author: Jun Hu

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目的

观察腓肠神经延迟皮瓣修复足部软组织缺损的临床应用效果。

方法

自2008年1月至2018年1月，甘肃省兰州市兰州手足外科医院骨科腓肠神经延迟皮瓣修复足部软组织缺损36例，男22，女14；年龄26~82岁，平均（50.5±20.4）岁；软组织缺损范围（6 cm×4.5 cm）~（22 cm×15 cm）；皮瓣延迟时间8~12 d，平均（9.7±2.4）d。皮瓣延迟期间创面暂时应用负压封闭引流覆盖。延迟皮瓣修复受区创面后，供区用中厚游离植皮修复。

结果

延迟皮瓣全部成活，2例皮瓣发生小的皮缘裂开，术后2周自然愈合。1例供区植皮发生小片坏死，经游离植皮愈合。术后随访1.5~4.5年，平均（3.5±1.4）年，所有软组织缺损修复成功，皮瓣颜色、质地与外形较好，本组取得了较满意的临床效果。

结论

腓肠神经延迟皮瓣修复足部软组织缺损安全、可靠，很适用于伴高风险患者或皮瓣切取较大者。

关键词: 软组织缺损, 腓肠神经, 延迟皮瓣, 足

Objective

To report the clinical effect of delayed sural neurocutaneous flap for the reconstruction of soft-tissue defect of the foot .

Methods

From January 2008 to January 2018, 36 patients (22 men and 12 women) with soft-tissue defect in the foot underwent reconstruction with a delayed sural neurocutaneous flap. They ranged in age from 26 to 82 years [mean of (50.5±20.4) years]. Soft-tissue defect size in the foot ranged from 16 cm×4.5 cm to 22 cm×15 cm. The delay period ranged from 8 to 12 days [mean of (9.7±2.4) days]. Temporary wound coverage was achieved by vacuum sealing drainage during the delay period. After the delayed flap was used to repair the wound of the recipient area, donor site was covered using split-thickness free skin grafts.

Results

All the delayed flaps had survived completely. Two flaps developed small wound dehiscence, which spontaneously healed 2 weeks after surgery. In one case, the skin grafts in the donor area had small necrosis and were healed with free skin grafts. Follow-up period ranged from 1.5 to 4.5 years [mean of (3.5±1.4) years] postoperatively. All soft-tissue defects were successfully repaired with good color, texture, and contour of the flaps. Satisfactory clinical results were obtained in this series.

Conclusion

Delayed sural neurocutaneous flap for reconstruction of soft-tissue defect of the foot is safe, reliable, and particularly suitable for high-risk patients or harvesting a large flap.

Key words: Soft-tissue defect, Sural nerve, Delayed flap, Foot

图1 腓肠神经延迟皮瓣修复足部软组织缺损患者情况及预后。图a为术前创面外形；图b为术前受区与皮瓣设计；图c为术中修复后供区与受区外形；图d为修复后4周外形；图e为术后1.5年受区外形；图f为术后1.5年供区外形

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Clinical effect of delayed sural neurocutaneous flap for reconstruction of soft-tissue defect of the foot