三种足跟部恶性黑色素瘤术后缺损修复皮瓣的临床疗效评价

【目的】评价足底内侧皮瓣、腓肠神经营养血管皮瓣和胫后动脉逆行皮瓣修复足跟部恶性黑色素瘤切除后软组织缺损的临床疗效，为临床的皮瓣选用提供参考。【方法】对应用足底内侧皮瓣10例、腓肠神经营养血管皮瓣11例和胫后动脉逆行皮瓣9例修复足跟部恶性黑色素瘤术后缺损的临床效果进行随访，比较分析三种皮瓣AOFAS踝-后足评分、损伤部位、触觉、压觉（Semmes—Weinstein单丝法）、动态和静态两点分辨觉（m2PD、s2PD）、温度觉、臃肿程度和瘢痕挛缩程度。【结果】术后皮瓣及植皮均顺利成活，创面均I期愈合；供区植皮均成活，切口I期愈合。皮瓣质地、颜色等均正常，无继发性溃疡发生。三种皮瓣的AOFAS踝-后足评分、瘢痕挛缩程度、皮瓣的臃肿程度、触觉、压觉、两点分辨觉和温度觉差异均无统计学意义。腓肠神经营养血管皮瓣的臃肿程度高于其他2种皮瓣，差异具有统计学意义（P〈0．05）。【结论】采用逆行腓肠神经营养皮瓣、足底内侧皮瓣和胫后动脉逆行皮瓣修复足跟部恶性黑色素瘤切除后软组织缺损，均可获得较好疗效，三种皮瓣各有特点，临床应该根据各种客观要求进行选择。

Evaluation of Clinical Efficacy of Three Flaps for Repairing Postoperative Defect of Retrocalca- neal Malignant Melanoma

Objective]To evaluate the clinical efficacy of medial plantar flap, sural neurocutaneous flap and retrograde posterior tibial artery flap for the reparation of soft tissue defects caused by resection of retro- calcaneal malignant melanoma in order to provide the reference for clinical choice of flaps. Methods] The clin ical efficacy of 10 patients undergoing medial plantar flap, 11 patients undergoing sural neurocutaneous flap and 9 patients undergoing retrograde posterior tibial artery flap for repairing postoperative defect of retrocalca- neal malignant melanoma were followed up. AOFAS ankle-hindfoot scores, touch, pressure（Semmes-Wein- stein monofilament test）, 2-point discrimination（motion 2PD and static 2PD）, thermal sensation, flap bulki- ness and donor site contracture of wounds were compared among three flaps. Results] All skin flaps or grafts after the operation survived smoothly. Wounds were one-stage healing. All grafts in supplying site survived. Incision was one-stage healing. The flaps had normal texture and color. No secondary ulcer occurred. There was no significant difference in AOFAS ankle-hindfoot scores, cicatricial contracture, touch, pressure, 2-point discrimination and thermal sensation among three flaps. The bulkiness of surat neurocutaneous flap was higher than that of other two flaps, and there was significant difference（ P 〈0.05）. ConclusionlRetrograde sural neurocutaneous flap, medial plantar flap and retrograde posterior tibial artery flap for the reparation of soft tis- sue defects caused by resection of retrocalcaneal malignant melanoma can achieve good clinical efficacy. The three flaps have their own characteristics. The choice of flap should be based on various clinical requirement.