外踝后穿支皮瓣修复足跟区皮肤缺损的疗效观察

目的观察外踝后穿支皮瓣修复足跟区皮肤缺损的临床应用效果。方法 2014年5月—2016年10月周口手外科医院收治跟外侧、后侧、足底、或跨区皮肤缺损者17例,其中男性12例,女性5例;年龄15~57岁,平均33.5岁。创伤所致皮肤跨区缺损14例、跟骨骨折切开复位内固定术后皮肤坏死致钢板外露3例,皮肤缺损范围2cm×4cm~7cm×10cm。合并跟骨骨折11例,其中跟骨骨质缺损6例,跟腱止点部位损伤5例;创面均采用外踝后穿支皮瓣修复,其中急诊修复9例,二期手术8例,对于伴有跟骨骨质缺损者通过取髂骨植骨方式修复、跟腱止点断裂损伤者重建修复。结果 16例皮瓣完全成活,1例皮瓣下血肿形成,未及时清除导致血循环障碍,皮瓣边缘局部皮肤坏死,经拆线引流等对症治疗后创缘愈合。17例经术后6个月~2年随访,皮瓣外形满意,跟骨愈合及跟腱抗应力性能良好。根据Marti后足(hindfoot)评分标准与Mackinnon感觉功能标准进行评定,行走功能及感觉恢复良好。结论应用外踝后上穿支皮瓣修复跟区皮肤组织缺损,临床效果满意。

Curative effect of lateral retromalleolar perforator flap in repair of heel skin defect

Objective To observe the curative effect of lateral retromalleolar perforator flap in repair of heel skin defect.Methods During May 2014 and Oct.2016,a total of 17 patients with lateral,posterior,plantar, or trans-regional skin defect were admitted into our department.There were 12 males and 5 females,with an average age of 33.5 years(15-57 years).Among them,14 cases had trans-regional skin defect induced by trauma,and 3 ca-ses showed exposure of the plate due to necrosis of the skin after open reduction and internal fixation of calcaneal fracture.Meanwhile,the range of skin defect was 2cm×4cm-7 cm×10cm.Furthermore,11 patients were found to have combined calcaneal fracture,among which there were 6 cases of bony defect of the calcaneus and 5 cases of A-chilles tendon insertion site injury.Wounds were repaired with lateral retromalleolar perforator flap,including 9 ca-ses of emergency repair and 8 cases of secondary operation.Patients with bony defect of the calcaneus were repaired using iliac crest bone graft,and patients with Achilles tendon insertion site injury received reconstruction.Results Of these flaps,16 survived completely,and 1 case failed for inefficient scavenge of hematoma formation under flap, resulting in blood circulation disorder and further local skin necrosis on the edge of flap,which was healed after the removal of stitches,drainage and other symptomatic treatment.All 17 patients were followed up for 6 months to 2 years,the appearance of the flap was satisfactory,indicating good healing of calcaneus and the stress resistance of A-chilles tendon.Additionally,walking function and sensation recovered well according to the score criterion of Marti hindfoot scale and Maryland foot score.Conclusion The clinical effect is satisfactory by applying lateral retromal-leolar perforator flap in repair of heel skin defect.