足踝部软组织缺损的显微外科修复
|
摘要
目的探讨不同皮瓣修复足踝部软组织缺损的方法及其疗效。方法采用带蒂皮瓣和游离皮瓣修复57例足踝部软组织缺损患者。带蒂皮瓣43例:腓肠神经营养血管皮瓣21例,胫后动脉穿支皮瓣15例,外踝上皮瓣5例,足底内侧皮瓣1例,跖背动脉皮瓣1例。游离皮瓣14例:股前外侧皮瓣13例,背阔肌皮瓣1例。结果 57例均顺利完成手术。患者均获得随访,时间3～12个月。术后2例皮瓣部分坏死,经换药、二期植皮修复; 1例皮瓣感染,经加强换药、扩创、抗炎、二期植皮治愈; 1例皮瓣边缘少许结痂,经换药治愈; 2例因术后皮瓣臃肿二期行皮瓣修整术; 1例因跟腱粘连导致踝关节背伸稍受限、跛行; 1例因跗跖关节不稳,行走时疼痛、跛行; 1例因距下关节融合、跟骨畸形愈合,行走时跛行、疼痛不明显; 1例足底外侧大小约0. 5 cm×0. 5 cm破溃增生,行走时跛行、疼痛不明显。其余患者皮瓣感觉、外观、功能均较满意。结论足踝部软组织缺损应根据创面情况选择适宜的皮瓣修复方法。
Objective To investigate the experience and curative effect of different flaps repairing soft tissue defect in ankle and foot. Methods The pedicled flap and free flap were used to repair the defect in 57 cases of ankle and foot soft tissue. The 43 cases of the pedicled flap: retrograde sural neurovascular flap was used in 21 cases,perforator flap of posterior tibial artery in 15 cases,lateral supramalleolar flap in 5 cases,medial plantar flap in 1 case,dorsal metatarsal artery flap in 1 case. The 14 cases of free flap: the femoral anterolateral skin flap in 13 cases,latissimus dorsi flap in 1 case. Results The 57 cases were successfully completed. All patients were followed up for 3 ～ 12 months.The 2 cases of flap partial necrosis got cure after dressing change,skin graft at two stage; 1 case of flap infection was cured by strengthening dressing change,debridement,anti inflammation,skin grafting at two stage; skin flaps of 1case the edge of a little scar,healed after dressing change; 2 cases with postoperative flap bloated two stage flap repair surgery; 1 case caused by ankle dorsiflexion,claudication due to limited tendon adhesion; 1 patient with tarsometatarsal joint instability,walking pain and limp; 1 case with subtalar arthrodesis and calcaneal malunion,walking limp,pain was not obvious; 1 case of lateral plantar ulceration size of about 0. 5 cm × 0. 5 cm hyperplasia,when walking claudication,pain was not obvious; the rest of the feeling,the appearance and function were satisfactory.Conclusions Appropriate repair methods should be chosen according to the wound surface in the repair of ankle and foot soft tissue defect.
Objective To investigate the experience and curative effect of different flaps repairing soft tissue defect in ankle and foot. Methods The pedicled flap and free flap were used to repair the defect in 57 cases of ankle and foot soft tissue. The 43 cases of the pedicled flap: retrograde sural neurovascular flap was used in 21 cases,perforator flap of posterior tibial artery in 15 cases,lateral supramalleolar flap in 5 cases,medial plantar flap in 1 case,dorsal metatarsal artery flap in 1 case. The 14 cases of free flap: the femoral anterolateral skin flap in 13 cases,latissimus dorsi flap in 1 case. Results The 57 cases were successfully completed. All patients were followed up for 3 ～ 12 months.The 2 cases of flap partial necrosis got cure after dressing change,skin graft at two stage; 1 case of flap infection was cured by strengthening dressing change,debridement,anti inflammation,skin grafting at two stage; skin flaps of 1case the edge of a little scar,healed after dressing change; 2 cases with postoperative flap bloated two stage flap repair surgery; 1 case caused by ankle dorsiflexion,claudication due to limited tendon adhesion; 1 patient with tarsometatarsal joint instability,walking pain and limp; 1 case with subtalar arthrodesis and calcaneal malunion,walking limp,pain was not obvious; 1 case of lateral plantar ulceration size of about 0. 5 cm × 0. 5 cm hyperplasia,when walking claudication,pain was not obvious; the rest of the feeling,the appearance and function were satisfactory.Conclusions Appropriate repair methods should be chosen according to the wound surface in the repair of ankle and foot soft tissue defect.
引文
[1]王峰,沈家泰,胡建波.隐神经大隐静脉营养血管皮瓣修复小腿及足跟部软组织缺损[J].临床骨科杂志,2017,20(1):67-69.
[2]黄俊,牛磊.大面积逆行性皮肤软组织撕脱伤重建静脉回流的临床疗效[J].临床骨科杂志,2018,21(1):70-72.
[2]黄俊,牛磊.大面积逆行性皮肤软组织撕脱伤重建静脉回流的临床疗效[J].临床骨科杂志,2018,21(1):70-72.