采用足底撕脱皮肤预制皮瓣游离修复足底软组织撕脱伤
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摘要
目的探讨采用足底撕脱皮肤预制皮瓣游离并修复足底软组织撕脱伤的临床效果。方法回顾性分析2011年10月至2015年1月,本院诊疗的20例足底软组织撕脱伤患者,清创撕脱离体的皮肤软组织,将其削薄后打包移植于股外侧中段筋膜上预制足底皮瓣。3周后皮瓣成活,再行二期皮瓣移植术将皮瓣游离回植原位。术后常规抗感染,改善微循环,清洁换药等。结果所有患者预制皮瓣血运丰富、全部成活,修复创面均一期愈合。但有2例患者发生血管危象和感染,探查发现部分皮缘坏死,经清洁换药后愈合。术后随访时间为6~24个月,平均为13个月,患者均恢复行走和负重能力。根据章鸣等制定的评定量表作为评定指标。其中优15例、良3例、可2例,优良率为90%。结论采用足底撕脱皮肤预制游离皮瓣修复足底软组织撕脱伤能取得满意效果,值得临床推广应用。
Objective To investigate the clinical effect of repairing the avulsion injury of the plantarsoft tissue with the prefabricated free skin flap. Methods From October 2011 to January 2015, 20 patientswith plantar soft tissue tearing degloving injury were retrospectively analyzed. The tore skin soft tissue wasgiven debridement, cut into thin pieces and packaged for transplantation into mid lateral fascia prefabricatedheel flap. On the postoperative 3 weeks after surviving, the skin flap was re-transplanted to the original site.Postoperatively the patients were given routine anti-infection, microcirculation was improved, and dressing wasperformed. Results The blood supply of the prefabricated flaps were abundant and survived in all patients.The repaired wound obtained one-state healing. The vascular crisis and infection occurred in 2 cases. Surgicalexploration revealed partial skin edge necrosis, which was restored to walking and weight-bearing capabilities.The patients were followed up for 6 to 24 months(average 13 months). The curative effects were assessed according to the guidelines issued by Zhang Ming et al. Fifteen cases obtained excellent curative effects, 3 cases good,and 2 cases general with excellent rate being 90%. Conclusion The clinical effects of plantar avulsion skinflap in the repair of plantar soft tissue avulsion injury are satisfactory, which is worthy of clinical application.
Objective To investigate the clinical effect of repairing the avulsion injury of the plantarsoft tissue with the prefabricated free skin flap. Methods From October 2011 to January 2015, 20 patientswith plantar soft tissue tearing degloving injury were retrospectively analyzed. The tore skin soft tissue wasgiven debridement, cut into thin pieces and packaged for transplantation into mid lateral fascia prefabricatedheel flap. On the postoperative 3 weeks after surviving, the skin flap was re-transplanted to the original site.Postoperatively the patients were given routine anti-infection, microcirculation was improved, and dressing wasperformed. Results The blood supply of the prefabricated flaps were abundant and survived in all patients.The repaired wound obtained one-state healing. The vascular crisis and infection occurred in 2 cases. Surgicalexploration revealed partial skin edge necrosis, which was restored to walking and weight-bearing capabilities.The patients were followed up for 6 to 24 months(average 13 months). The curative effects were assessed according to the guidelines issued by Zhang Ming et al. Fifteen cases obtained excellent curative effects, 3 cases good,and 2 cases general with excellent rate being 90%. Conclusion The clinical effects of plantar avulsion skinflap in the repair of plantar soft tissue avulsion injury are satisfactory, which is worthy of clinical application.
引文
[1]蔡国荣,张功林,郑良军,等.以撕脱手掌皮肤预制游离皮瓣修复手掌缺损一例[J].中华整形外科杂志,2007,23(2):176-177.
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[3]Shanahan RE,Gingrass RD.Medial plantar sensory flap for cover-age heel defects[J].Plast Reconstr Surg,1979,64(3):295-298.
[4]Lykoudis EG,Seretis K,Lykissas MG.Free sensate medial plantarflap for contralateral plantar forefoot reconstruction with flap rein-nervation using end-to-side neurorrhaphy:a case report and litera-ture review[J].Microsurgery,2013,33(3):227-231.
[5]章鸣,郭翱,张功林,等.足跟撕脱皮肤寄养预制皮瓣修复足跟软组织撕脱伤[J].中华显微外科杂志,2010,33(5):404-405.
[6]郭翱,张功林,李俊,等.应用预制皮瓣修复足底负重区软组织撕脱伤[J].中华显微外科杂志,2012,35(6):512-513.
[7]徐雷.皮瓣的外科的过去、现在和未来[J].骨科,2015,6(5):225-228.
[8]丁伟,徐雷,杨超群,等.逆行股前外侧岛状皮瓣修复膝关节周围软组织缺损[J].骨科,2015,6(5):231-233.
[9]Oh SJ,Moon M,Cha J,et al.Weight-bearing plantar reconstructionusing versatile medial plantar sensate flap[J].J Plast ReconstrAesthet Surg,2011,64(2):248-254.
[10]Fujioka M,Hayashida K,Senju C.Reconstruction of lateral fore-foot using reversed medial plantar flap with free anterolateral thighflap[J].J Foot Ankle Surg,2014,53(3):324-327.
[2]章鸣,郭翱,刘升辉,等.皮瓣修复足跟部软组织缺损疗效的研究[J].中华显微外科杂志,2009,32(6):458-460.
[3]Shanahan RE,Gingrass RD.Medial plantar sensory flap for cover-age heel defects[J].Plast Reconstr Surg,1979,64(3):295-298.
[4]Lykoudis EG,Seretis K,Lykissas MG.Free sensate medial plantarflap for contralateral plantar forefoot reconstruction with flap rein-nervation using end-to-side neurorrhaphy:a case report and litera-ture review[J].Microsurgery,2013,33(3):227-231.
[5]章鸣,郭翱,张功林,等.足跟撕脱皮肤寄养预制皮瓣修复足跟软组织撕脱伤[J].中华显微外科杂志,2010,33(5):404-405.
[6]郭翱,张功林,李俊,等.应用预制皮瓣修复足底负重区软组织撕脱伤[J].中华显微外科杂志,2012,35(6):512-513.
[7]徐雷.皮瓣的外科的过去、现在和未来[J].骨科,2015,6(5):225-228.
[8]丁伟,徐雷,杨超群,等.逆行股前外侧岛状皮瓣修复膝关节周围软组织缺损[J].骨科,2015,6(5):231-233.
[9]Oh SJ,Moon M,Cha J,et al.Weight-bearing plantar reconstructionusing versatile medial plantar sensate flap[J].J Plast ReconstrAesthet Surg,2011,64(2):248-254.
[10]Fujioka M,Hayashida K,Senju C.Reconstruction of lateral fore-foot using reversed medial plantar flap with free anterolateral thighflap[J].J Foot Ankle Surg,2014,53(3):324-327.