足踝部皮肤缺损的修复宫旭1路来金1李雷刚2【摘要】目的探讨足踝部皮肤缺损的修复方法及疗效。方法2000年1月～2005年10月,对36例足踝部皮肤缺损分别采用同侧外踝上皮瓣或逆行腓肠神经营养皮瓣修复,其中男35例,女1例。年龄6～62岁,平均38岁。损伤原因:机器伤12例,车祸伤22例,感染1例,冻伤1例。其中急诊行皮瓣修复24例,12例于伤后7d～1个月手术,修复部位包括足背、足跟、前足和内、外踝,皮肤缺损范围5cm×4cm～20cm×10cm。其中外踝上皮瓣15例15个皮瓣,切取皮瓣范围5cm×4cm～15cm×8cm;逆行腓肠神经营养皮瓣21例22个皮瓣,切取皮瓣范围6cm×4cm～20cm×10cm。就其术后疗效及两种皮瓣的成活率进行比较。结果术后外踝上皮瓣完全成活10个,完全坏死3个,尖端部分坏死2个。逆行腓肠神经营养皮瓣完全成活21个,其中3个尖端出现表皮坏死;1个在术中即出现动脉供血不足,改行其他方法修复。术后经3周～6个月随访,两种皮瓣修复后的疗效相似,皮肤质地、厚度与足踝部相接近,皮瓣的痛、触觉为S0～S1。修复足跟跖侧的两种皮瓣术后均较臃肿,皮瓣与跟骨之间存在滑动,皮瓣表面出现压迫性表皮坏死。结论外踝上皮瓣适用于内外踝部、足背近侧等距皮瓣供区较近的部位,皮肤缺损面积相对较小的创面;对于缺损较大或距离踝关节较远的足部创面,应采用逆行腓肠神经营养皮瓣,但有踝关节动脉网破坏严重时需谨慎应用。【关键词】足踝部逆行腓肠神经皮瓣外踝上皮瓣修复中图分类号:R658.3R622文献标识码:ACOMPARISONBETWEENTWODIFFERENTREPAIRINGMETHODSFORSKINDEFECTSOFFOOTANDANKLE�GONGXu,LULaijin,LILeigang.DepartmentofHandSurgery,FirstHospitalofJilinUniversity,ChangchunJilin,130021,P.R.ChinaCorrespondingauthor:LULaijin,E2mail:lulaijin@hotmail.com【Abstract】ObjectiveToexploreasuitablerepairingmethodforskindefectsofthefootandankle,andtoevaluatethetherapeuticeffectsofthedifferentrepairingmethods.MethodsFromJanuary2000toOctober2005,36patientswithskindefectsofthefootandankleunderwenttherepairingtreatment,ofwhom35weremalesand1wasfemale,aged5262years,averaged38years.Ofthe36patients,12hadaninjurybyamachine,22hadatrafficaccident,1hadaninfection,and1hadacoldinjury.Andtheinjuriesinvolvedthedorsumofthefoot,heel,forefoot,andmedialorlateralmalleolus.Theinjurieswererespectivelytreatedby2differentrepairingmethods,therepairwiththecoveragebythelateralsupramalleolarflapsandtherepairwiththecoveragebythereversesuralneurocutaneousflaps.Theskindefectsrangedinareafrom5cm×4cmto20cm×10cm.Thelateralsupramalleolarflapwasusedin15patients(15flaps)withaflapareaof5cm×4cm215cm×8cm,andthereversesuralneurocutaneousflapwasusedin21patients(22flaps)withaflapareaof6cm×4cm220cm×10cm.Weretrospectivelyobservedthetherapeuticresultsandcomparedthesuccessratesofthetwomethods.ResultsOfthe36patients,15underwenttherepairwiththecoverageby15lateralsupramalleolarflaps;10achievedacompletesurvivaloftheflaps,2developedanepidermalnecrosisoverthedistalpart,and3developedacompletenecrosis.Theother21patientsunderwenttherepairwiththecoverageby22reversesuralneurocutaneousflaps.Ofthe22flaps,21hadacompletesurvival,andonly1failedtosurvive.Thecomparisonrevealedthattherewasnodifferenceinthecolor,texture,andcontouroftheflapsbetweenthe2repairedgroups.Andthepatientsinthe2groupswereequallysatisfiedwiththerepairingtreatments.ThesensationoftheflapsrecoveredtoS02S1.ConclusionTherepairingofthefootandankleskindefectswiththecoveragebythelateralsupramalleolarflapsorbythereversesuralneurocutaneousflapscanachieveasimilargoodtherapeuticresult.However,therepairwiththelateralsupramalleolarflapsismoresuitablefortheskindefectofasmallerareaoverthemedialorlateralmalleolus,ortheproximaldorsumofthefoo...
