CAJ | 학술논문

目的探讨股前外侧皮瓣移植修复足跟大面积软组织缺损的感觉重建方法及其临床疗效. 方法 2005年10月至2010年10月收治足跟大面积软组织缺损25例,依据前期对股外侧皮神经、跟内侧神经和跟外侧神经的解剖和截面形态研究结果,设计、切取股前外侧皮瓣和股外侧皮神经,感觉重建采用股外侧皮神经预制成形与跟内侧神经缝合14例、跟外侧神经缝合2例,采用神经束膜结合外膜缝合法将股外侧皮神经与跟内侧神经缝合3例、跟外侧神经缝合3例,采用小间隙缝合法将股外侧皮神经与跟外侧神经缝合3例,全部病例均选择股外侧皮神经在髂前上棘下5～7cm的平面与跟内和(或)外侧神经起始部缝合.术后测试皮瓣的痛觉、触觉、温度觉和两点辨别觉,了解患者负重、行走功能恢复情况及有无溃疡发生. 结果 25例股前外侧皮瓣全部成活,修复创面一期愈合.术后随访9～36个月(平均18个月),所有皮瓣恢复保护性感觉,S3+5例,S310例,S2 10例,感觉恢复优良率为60％,负重和行走能力获得恢复,无一例发生溃疡. 结论应用股前外侧皮瓣修复足跟大面积软组织缺损感觉重建时,注意股外侧皮神经的分布及变异情况,选择合适的受区皮神经和吻合部位,依据神经截面的不同形态特点选择合适的神经缝合方法可以明显改善股前外侧皮瓣的感觉功能恢复.
목적 탐토고전외측피판이식수복족근대면적연조직결손적감각중건방법급기림상료효. 방법 2005년10월지2010년10월수치족근대면적연조직결손25례,의거전기대고외측피신경、근내측신경화근외측신경적해부화절면형태연구결과,설계、절취고전외측피판화고외측피신경,감각중건채용고외측피신경예제성형여근내측신경봉합14례、근외측신경봉합2례,채용신경속막결합외막봉합법장고외측피신경여근내측신경봉합3례、근외측신경봉합3례,채용소간극봉합법장고외측피신경여근외측신경봉합3례,전부병례균선택고외측피신경재가전상극하5～7cm적평면여근내화(혹)외측신경기시부봉합.술후측시피판적통각、촉각、온도각화량점변별각,료해환자부중、행주공능회복정황급유무궤양발생. 결과 25례고전외측피판전부성활,수복창면일기유합.술후수방9～36개월(평균18개월),소유피판회복보호성감각,S3+5례,S310례,S2 10례,감각회복우량솔위60％,부중화행주능력획득회복,무일례발생궤양. 결론 응용고전외측피판수복족근대면적연조직결손감각중건시,주의고외측피신경적분포급변이정황,선택합괄적수구피신경화문합부위,의거신경절면적불동형태특점선택합괄적신경봉합방법가이명현개선고전외측피판적감각공능회복.
Objective To explore new methods of innervating the anterolateral thigh flap(ALTF) for repairing widespreadly traumatic soft tissue defects in heel and report their initial results of clinical application. Methods Twenty-five consecutive ALTFs were transplanted in 25 patients for repairing widespreadly traumatic soft tissue defects in heel from October 2005 to October 2010. Three ways were used in this series for sensory reconstruction of ALTFs,which based on the primary researches of the anatomic and histomorphological characteristics of lateral femoral cutaneous nerve (LFCN),medial calcaneal nerve (MCN) and lateral calcaneal nerve (LCN). The first way which was of suture between reshaped LFCN and MCN or LCN was used in 16 cases, the second way which was of perineurial suture combined with epineurial suture was used in 6 cases,and the small-gap-suture way was used in the remaining cases.The section of LFCN 5-7 cm below the anterior superior iliae spine and the initial segment of MCN or LCN were selected as anastomotic position. Postoperative follow-up parameters include pain sensation, touch sensation, thermal sensibility and static two-point discrimination. Results All flaps survived,and the wounds were primary intention.Twentyfive cases followed up 9-36 months (18 months on average).All flaps restored protective sensation,and the rate of good sensory recovery was 60％. All patients restored weighing and walking, and no ulceration happened. Conclusion Satisfactory sensory function restoration can be obtained by paying attention to the distribution and variety of LFCNs, selecting suitable cutaneous nerves and rational coaptated position as well as suitable suturation means which based on the anatomic and histomorphologieal characteristics of LFCN,MCN and LCN when repairing widespread soft tissue defects in heel.