低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面VIP免费

中国修复重建外科杂志2008年11月第22卷第11期·1285·低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面陈玉兵徐永清陆声【摘要】目的探讨低旋转点隐神经营养血管远端蒂皮瓣修复前足背侧缺损创面的术式，并总结其临床效果。方法2005年1月－2007年8月，应用低旋转点的隐神经营养血管远端蒂皮瓣修复前足背侧皮肤软组织缺损创面6例。男4例，女2例；年龄28～53岁。左足2例，右足4例。重物压砸伤5例，车祸伤1例。患足均伴肌腱、骨外露或坏死皮肤软组织切除后肌腱、骨外露。急诊手术2例，择期手术4例。清创后创面缺损为7.0cm×5.0cm～9.0cm×5.5cm。皮瓣旋转点位于内踝上1～3cm处，切取皮瓣大小为8.0cm×6.0cm～13.0cm×6.5cm。其中2例将皮瓣内隐神经近断端和创面内足背内侧皮神经残端吻合。供区创面中厚皮片植皮修复。结果4例术后皮瓣顺利成活；2例术后2d皮瓣远端出现肿胀、水疱，经对症处理后愈合。供区植皮全部成活。6例患者均获随访，随访时间6～18个月。皮瓣厚薄、颜色及质地接近受区。术中吻合神经的2例皮瓣痛、温觉恢复，两点辨别觉分别为8mm和9mm；未吻合神经的4例皮瓣恢复保护性感觉。患足负重行走正常，皮瓣无皮肤破溃。结论低旋转点的隐神经营养血管远端蒂皮瓣血供可靠，是修复前足背侧缺损创面的一种较好方法。【关键词】隐神经前足软组织缺损皮瓣修复中图分类号：R622.1R658.3文献标志码：ADISTALLYBASEDSAPHENOUSNEUROCUTANEOUSFLAPOFLOWERROTATINGPOINTREPAIRINGSOFTTISSUEDEFECTINDORSUMOFFOREFOOT/CHENYubing,XUYongqing,LuSheng.DepartmentofOrthopaedics,KunmingGeneralHospitalofChengduMilitaryCommandandClinicalInstitutionofKunmingMedicalCollege,KunmingYunnan,650032,P.R.China.Correspondingauthor:CHENYubing,E-mail:chenyubingsd@126.com【Abstract】ObjectiveToinvestigatethesurgicalmethodsandclinicalresultsofreconstructingsofttissuedefectsindorsumofforefootwithdistallybasedsaphenousneurocutaneousflapoflowerrotatingpoint.MethodsFromJanuary2005toAugust2007,6casesofsofttissuedefectsindorsumofforefoot,including4malesand2femalesaged28-53years,weretreatedwiththedistallybasedsaphenousneurocutaneousflapsoflowerrotatingpoint.Thesofttissuedefectwasinleftfootin2casesandinrightfootin4cases.Fivecasesofsofttissuedefectswerecausedbycrush,and1casewascausedbytrafficaccident.Tendonsandboneswereexposedinallcases.Thedefectsafterdebridementwere7.0cm×5.0cmto9.0cm×5.5cminsize.Emergencyoperationwasperformedin2casesandselectiveoperationin4cases.Rotatingpointoftheflapswasfrom1to3cmabovemedialmalleolus.Thesizeoftheflapsrangedfrom8.0cm×6.0cmto13.0cm×6.5cm.Neuroanastomosiswasperformedin2casesoftheflaps.Skindefectsindonorsitewererepairedwiththicknessskingraft.ResultsFourcasesofthetransferredflapssurvivedcompletelyandtheother2casesbegantoswellandemergewaterblisterfromthedistantendoftheflapafteroperation,whichresultedindistalsuperficialnecrosisofflaps,healingwasachievedafterchangedressingsandskingrafted.Skingraftindonorsitesurvivedcompletelyinallcases.Allcaseswerefollowedupfrom6to18months.Thecolorandtextureandthicknessoftheflapsweresimilartorecipientsite.Painsensationandwarmthsensationofthe2flapswhosecutaneousnervewereanastomosedrecoveredcompletely,twopointdiscriminationwere8mmand9mmrespectively.Sensationandwarmthsensationofthe4flapswhosecutaneousnervewerenotanastomosedrecoveredpartly.Allpatientsreturnedtotheirnormalwalkingandrunningactivitiesandnoulcerationoccurred.Nodonorsitemorbiditywasencountered.ConclusionBloodsupplyofthedistallybasedsaphenousneurocutaneousflapoflowerrotatingpointissufficient,theflapisespeciallyusefulforrepairofsofttissuedefectsindorsumofforefoot.【Keywords】SaphenousnerveForef...