CAJ | 학술논문

目的探讨远端蒂腓肠神经营养血管皮瓣的近端位置对皮瓣部分坏死的影响.方法回顾性分析2001年4月至2009年5月应用远端蒂腓肠神经营养血管皮瓣转移修复小腿下段及足踝部创面的病例资料,共153位患者157例皮瓣.将小腿后面从外踝尖至腘窝横纹等分为9个区,从下至上依次为第1至第9区.皮瓣分为成活组(包括完全成活、远端表皮坏死和伤口裂开的皮瓣)和部分坏死组;根据皮瓣近端位置,将皮瓣分为近端不超过第6区(A组)、位于第7区(B组)、第8区(C组)和第9区即小腿上1/9区段(D组)4个组.皮瓣采用顺逆结合法切取.结果皮瓣完全成活125例;远端表皮坏死8例,远端伤口裂开6例;远端部分坏死18例(11.5%).A、B、C和D组皮瓣部分坏死率分别为0(0/19)、2.3%(1/44)、11.3%(7/62)和31.3%(10/32),A组与B组、B组与C组比较,皮瓣部分坏死率的差异均无统计学意义(P＞0.05);皮瓣部分坏死率:D组高于C组(P=0.012)、近端位于小腿下7/9区域的皮瓣(1.6%,1/63)低于小腿上2/9区域的皮瓣(18.1%,17/94),差异均有统计学意义(P=0.001).结论远端蒂腓肠神经营养血管皮瓣的近端不超过小腿下7/9与上2/9交界线时,皮瓣成活可靠;皮瓣近端位于小腿上1/9区段时,皮瓣部分坏死的可能性明显增大.
목적 탐토원단체비장신경영양혈관피판적근단위치대피판부분배사적영향.방법 회고성분석2001년4월지2009년5월응용원단체비장신경영양혈관피판전이수복소퇴하단급족과부창면적병례자료,공153위환자157례피판.장소퇴후면종외과첨지객와횡문등분위9개구,종하지상의차위제1지제9구.피판분위성활조(포괄완전성활、원단표피배사화상구렬개적피판)화부분배사조;근거피판근단위치,장피판분위근단불초과제6구(A조)、위우제7구(B조)、제8구(C조)화제9구즉소퇴상1/9구단(D조)4개조.피판채용순역결합법절취.결과 피판완전성활125례;원단표피배사8례,원단상구렬개6례;원단부분배사18례(11.5%).A、B、C화D조피판부분배사솔분별위0(0/19)、2.3%(1/44)、11.3%(7/62)화31.3%(10/32),A조여B조、B조여C조비교,피판부분배사솔적차이균무통계학의의(P＞0.05);피판부분배사솔:D조고우C조(P=0.012)、근단위우소퇴하7/9구역적피판(1.6%,1/63)저우소퇴상2/9구역적피판(18.1%,17/94),차이균유통계학의의(P=0.001).결론 원단체비장신경영양혈관피판적근단불초과소퇴하7/9여상2/9교계선시,피판성활가고;피판근단위우소퇴상1/9구단시,피판부분배사적가능성명현증대.
Objective To explore the influence of proximal-tip location on partial necrosis in distally based sural neurofasciocutaneous flap. Methods From April 2001 to May 2009,157 distally based sural neurofasciocutaneous flaps were conducted to repair the soft tissue defect in distal region of lower leg, ankle and feet in 153 patients. Date of the flaps and the patients were retrospectively analyzed.From the tip of lateral malleolus to the popliteal crease, posterior aspect of the lower leg was equally divided into 9 regions that were 1st to 9th region from inferiorly to superiorly, respectively. The flaps were divided into 2 groups: survial group(including unevenffully survived flaps, flaps with distally epidermical necrosis and with wound dehiscence)and partial necrosis group. Based on the location of the proximal tip of flaps,the flaps were stratified into 4 groups:flaps with the proximal tip locating in the 6th or lower region(group A), the 7th region(group B),the 8th region(group C)and the 9th region(group D). Harvesting the flaps started from exploring the perforator of peroneal vessel in the adipofascial pedicle , then the flaps were elevated retrogradely. Results Of the 157 flaps, 125 survived uneventfully, 8 showed distal epidermal necrosis,wound dehiscence occurred in 6 flaps, 18 flaps(11.5%)showed distal partial necrosis. Partial necrosis occurred in zero of 19 flaps in group A(0), 1 of 44 flaps in group B(2.3%), 7 of 62 flaps in group C(11.3%)and 10 of 32 flaps in group D(31.3%). The differences in partial necrosis rate between group A and group B 、group B and group C,were not statistically significant (P ＞0. 05). Partial necrosis rate was higher in group D than in group C(P =0. 012),it was lower in group A + group B(1.6%)than in group C + group D (18.1%)(P = 0. 001). Conclusions Distally based sural neurofasciocutaneous flap can survive reliably when the proxiamal tip of flap is not beyond the junction between lower 7/9 and upper 2/9 of the lower leg, whereas probability of partial necrosis occuring in the flap increase significantly when the proximal tip of flap locates in upper 1/9 of the lower leg.