邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效
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摘要
目的探讨邻近逆行穿支带蒂双皮瓣修复足部贯通伤的治疗经验及临床疗效。方法2010年1月至2014年7月,我科收治9例足部贯通伤病人,伤足均有不同程度的两侧软组织缺损,早期彻底清创、止血,大量液体冲洗下负压封闭引流覆盖创面,择期以邻近逆行带蒂腓肠神经营养血管皮瓣和内踝上皮瓣一次性修复两侧皮肤软组织缺损。术后观察皮瓣存活情况,并采用美国足踝外科医师协会(AOFAS)踝与后足功能评分系统评价伤足的恢复情况。结果术后2例皮瓣边缘坏死,分别经换药和植皮后成活;1例外侧皮瓣创口长时间渗液,经换药引流,4周后愈合;其余病人皮瓣均顺利成活,供区创面一期愈合。本组9例均获随访,病人对其外形、色泽、厚度可接受。AOFAS踝与后足功能评分系统评价均为优。结论邻近逆行穿支带蒂双皮瓣是修复足部贯通伤的有效方法,围手术期处理使污染创面变成相对清洁创面是皮瓣成功的基础条件,合理选择、设计皮瓣,深筋膜充分填塞创腔是治疗成功的关键。
Objective To explore the treatment methods and clinical effectiveness of double adjacentperforator flaps with pedicle for repairing penetrating wound of feet. Methods Between January 2010 and July 2014, 9 patients with penetrating wound of feet were surgically treated in our hospital. The feet had differentdegrees of bilateral skin and soft tissue defects. After debridement, hemostasis, flushing, and drainage withVSD technology, penetrating wound of feet was repaired with sural neurouascular and medial supramalleolarperforator flaps with pedicle in a one-stage procedure. The flap survival conditions were observed after opera-tion, and the American Orthopaedic Foot and Ankle Society(AOFAS) scoring system was used to evaluate therecovery of the affected feet. Results Two cases had partial skin necrosis at the distal site: one case healedafter dressing, and the other healed after applying additional dermoplasty. In another case, flap blood supplywas good, but the wound was continuous discharging, which was healed through dressing and drainage over 4 weeks. The rest of the flaps survived, as well donor wounds primarily healed. All cases were followed up, andthe satisfaction rate of patients was 100% in its shape, color and thickness. Conclusion Double adjacentperforator flaps with pedicle for repairing penetrating wound of feet could achieve better outcomes, and hadpreferable value in clinical application. Perioperative treatment that making the contaminated wound intorelatively clean wound was the basis of the flap survived, and reasonable design of skin flap, and fully filling ofcavity in the deep fascia were the key to the success of the treatment.
Objective To explore the treatment methods and clinical effectiveness of double adjacentperforator flaps with pedicle for repairing penetrating wound of feet. Methods Between January 2010 and July 2014, 9 patients with penetrating wound of feet were surgically treated in our hospital. The feet had differentdegrees of bilateral skin and soft tissue defects. After debridement, hemostasis, flushing, and drainage withVSD technology, penetrating wound of feet was repaired with sural neurouascular and medial supramalleolarperforator flaps with pedicle in a one-stage procedure. The flap survival conditions were observed after opera-tion, and the American Orthopaedic Foot and Ankle Society(AOFAS) scoring system was used to evaluate therecovery of the affected feet. Results Two cases had partial skin necrosis at the distal site: one case healedafter dressing, and the other healed after applying additional dermoplasty. In another case, flap blood supplywas good, but the wound was continuous discharging, which was healed through dressing and drainage over 4 weeks. The rest of the flaps survived, as well donor wounds primarily healed. All cases were followed up, andthe satisfaction rate of patients was 100% in its shape, color and thickness. Conclusion Double adjacentperforator flaps with pedicle for repairing penetrating wound of feet could achieve better outcomes, and hadpreferable value in clinical application. Perioperative treatment that making the contaminated wound intorelatively clean wound was the basis of the flap survived, and reasonable design of skin flap, and fully filling ofcavity in the deep fascia were the key to the success of the treatment.
引文
[1]侯训凯,王炳臣,林永杰,等.封闭式负压引流技术联合皮瓣移植修复足部严重软组织缺损[J].中国矫形外科杂志,2015,23(19):1779-1782.
[2]Penn-Barwell JG,Brown KV,Fries CA.High velocity gunshotinjuries to the extremities:managementon and off the battle-field[J].Curr Rev Musculoskelet Med,2015,8(3):312-317.
[3]Dissemond J,Augustin M,Eming SA,et al.Modern wound care-practical aspects of non-interventional topical treatment of patientswith chronic wounds[J].J Dtsch Dermatol Ges,2014,12(7):541-554.
[4]De la Rosa-Massieu D,González-Sánchez M,Onishi-Sadud W,etal.[Severe hand injury due to a high-energy gunshot projectiletreated with arthrodesis of the carpus,synthetic bone graft andexternal fixators.Case report][J].Acta Ortop Mex,2014,28(4):240-243.
[5]章斌,郭锦明,刘俊,等.胫后动脉内踝上皮支皮瓣修复小腿远端及足踝部皮肤软组织缺损[J].中国骨与关节损伤杂志,2013,28(4):383-384.
[6]郭海军,任伟.血清降钙素原与C反应蛋白在细菌性感染诊断中的价值研究[J].中国生化药物杂志,2014,34(9):152-153,156.
[7]Saydam FA,Basaran K,Ceran F,et al.Foot ischemia after a freefibula flap harvest:immediate salvage with an interpositionalsapheneous vein graft[J].J Craniofac Surg,2014,25(5):1784-1786.
[8]Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating sys-tems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9]于云聚,于爱萍,郭占山,等.创面应用生理盐水冲洗量与细菌残留量相关临床研究[J].中国伤残医学,2011,19(12):5-6.
[10]Turker T,Capdarest-Arest N.Management of gunshot wounds tothe hand:a literature review[J].J Hand Surg Am,2013,38(8):1641-1650.
[11]Baechler MF,Groth AT,Nesti LJ,et al.Soft tissue management ofwar wounds to the foot and ankle[J].Foot Ankle Clin,2010,15(1):113-138.
[12]马建文.足踝部皮肤软组织缺损治疗中应用负压封闭引流技术疗效观察[J].中国矫形外科杂志,2012,20(12):1097-1099.
[13]Leclère FM,Casoli V.Reconstruction of a traumatic plantar footdefect with a novel free flap:The medial triceps brachii freeflap[J].J Cosmet Laser Ther,2015,17(5):286-289.
[14]张贵春,曹学成,郑金龙.皮瓣修复创伤性软组织缺损:骨骼肌关节囊及钢板的处理原则[J].中国组织工程研究,2014,18(42):6832-6837.
[15]van Waes OJ,Halm JA,Vermeulen J,et al.“The Practical Per-forator Flap”:the sural artery flap for lower extremity soft tissuereconstruction inwounds of war[J].Eur J Orthop Surg Traumatol,2013,23 Suppl 2:S285-S289.
[16]Liu L,Zou L,Cao X,et al.Two different flaps for reconstruction ofgunshot wounds to the foot and ankle in a child[J].J Pediatr Surg,2012,47(9):E13-E17.
[17]Kallio M,Vikatmaa P,Kantonen I,et al.Strategies for free flaptransfer and revascularisation with long-term outcome in the treat-ment of large diabetic foot lesions[J].Eur J Vasc Endovasc Surg,2015,50(2):223-230.
[2]Penn-Barwell JG,Brown KV,Fries CA.High velocity gunshotinjuries to the extremities:managementon and off the battle-field[J].Curr Rev Musculoskelet Med,2015,8(3):312-317.
[3]Dissemond J,Augustin M,Eming SA,et al.Modern wound care-practical aspects of non-interventional topical treatment of patientswith chronic wounds[J].J Dtsch Dermatol Ges,2014,12(7):541-554.
[4]De la Rosa-Massieu D,González-Sánchez M,Onishi-Sadud W,etal.[Severe hand injury due to a high-energy gunshot projectiletreated with arthrodesis of the carpus,synthetic bone graft andexternal fixators.Case report][J].Acta Ortop Mex,2014,28(4):240-243.
[5]章斌,郭锦明,刘俊,等.胫后动脉内踝上皮支皮瓣修复小腿远端及足踝部皮肤软组织缺损[J].中国骨与关节损伤杂志,2013,28(4):383-384.
[6]郭海军,任伟.血清降钙素原与C反应蛋白在细菌性感染诊断中的价值研究[J].中国生化药物杂志,2014,34(9):152-153,156.
[7]Saydam FA,Basaran K,Ceran F,et al.Foot ischemia after a freefibula flap harvest:immediate salvage with an interpositionalsapheneous vein graft[J].J Craniofac Surg,2014,25(5):1784-1786.
[8]Kitaoka HB,Alexander IJ,Adelaar RS,et al.Clinical rating sys-tems for the ankle-hindfoot,midfoot,hallux,and lesser toes[J].Foot Ankle Int,1994,15(7):349-353.
[9]于云聚,于爱萍,郭占山,等.创面应用生理盐水冲洗量与细菌残留量相关临床研究[J].中国伤残医学,2011,19(12):5-6.
[10]Turker T,Capdarest-Arest N.Management of gunshot wounds tothe hand:a literature review[J].J Hand Surg Am,2013,38(8):1641-1650.
[11]Baechler MF,Groth AT,Nesti LJ,et al.Soft tissue management ofwar wounds to the foot and ankle[J].Foot Ankle Clin,2010,15(1):113-138.
[12]马建文.足踝部皮肤软组织缺损治疗中应用负压封闭引流技术疗效观察[J].中国矫形外科杂志,2012,20(12):1097-1099.
[13]Leclère FM,Casoli V.Reconstruction of a traumatic plantar footdefect with a novel free flap:The medial triceps brachii freeflap[J].J Cosmet Laser Ther,2015,17(5):286-289.
[14]张贵春,曹学成,郑金龙.皮瓣修复创伤性软组织缺损:骨骼肌关节囊及钢板的处理原则[J].中国组织工程研究,2014,18(42):6832-6837.
[15]van Waes OJ,Halm JA,Vermeulen J,et al.“The Practical Per-forator Flap”:the sural artery flap for lower extremity soft tissuereconstruction inwounds of war[J].Eur J Orthop Surg Traumatol,2013,23 Suppl 2:S285-S289.
[16]Liu L,Zou L,Cao X,et al.Two different flaps for reconstruction ofgunshot wounds to the foot and ankle in a child[J].J Pediatr Surg,2012,47(9):E13-E17.
[17]Kallio M,Vikatmaa P,Kantonen I,et al.Strategies for free flaptransfer and revascularisation with long-term outcome in the treat-ment of large diabetic foot lesions[J].Eur J Vasc Endovasc Surg,2015,50(2):223-230.