足背部软组织缺损的创面修复

目的 探讨不同种类皮瓣修复致足背部软组织缺损的技术要点和临床疗效.方法 对32例足背部软组织缺损患者进行创面修复：以腓动脉穿支为远端蒂的腓肠神经营养血管皮瓣修复15例,以胫前动脉穿支为远端蒂的腓浅神经营养血管皮瓣修复8例,以旋股外侧动脉降支供养的股前外侧游离皮瓣修复9例.足背部软组织缺损范围5 cm×5 cm-30 cm×20 cm.结果 32例皮瓣均成活.1例皮瓣远端表皮坏死、2例皮瓣远端部分坏死,均经换药后痊愈.32例均获随访,时间6-12个月.成活皮瓣外观、质地和厚度与足背部受区相似,无溃疡发生,有保护性感觉,两点辨别觉5-10 mm.患者步态行走正常,均表示满意.结论合理选择不同种类皮瓣修复足背部软组织缺损可有效提高成活率,并重建肢体形态功能.

The repair of soft tissue defect caused by high energy injury in dorsum pedis region using different flaps

Objective To study the technical principle and clinical effect of different flaps to repair the soft tissue defect caused by high energy injury in dorsum pedis. Methods Thirty two patients of soft tissue defect in dorsum pedis were repaired by different flaps. The soft-tissue defects in the dorsum pedis were repaired by sural neurocutaneous flaps based on the distal peroneal perforators in 15 cases and superficial peroneal neurocutaneous flaps based on the distal perforators of anterior tibial artery in 8 cases. The soft-tissue defects in the external malleolus and proximal dotsum pedis were covered by anterolateral thigh flaps based on the lateral femoral circumflex artery in 9 cases. The dimension of soft tissue defects ranged from 5 cm ×5 cm to 30 cm × 20 cm in dorsum pedis region. Results Of the 32 patients, 29 achieved survival of the flaps, 1 developed an epidermal necrosis over the distal part, and 2 developed necrosis over the distal part. The wound healing was achieved after dressing change. The follow-up duration ranged from 6 to 12 months. There was no difference in the appearance, texture and contour between the flaps and receptor in dorsum pedis region. The flaps had no ulcer occurred and good protective sense. The two point discrimination of the flap was 5 mm to 10 mm. All patients were satisfied with the flap appearance and walking pattern was normal. Conclusions It is important to make reasonable evaluation and choice of the different flaps to repair the soft tissue defects in dorsum pedis region in order to elevate the survival rate of the flaps and reconstruct limb function.