CAJ | 학술논문

目的：探讨3种不同形状蒂部减张瓣在皮神经营养皮瓣逆行转移术中的应用及其疗效。方法：自2006年1月至2012年1月，皮瓣坏死患者21例，男15例，女6例；年龄14～58岁，平均35岁；应用三角形、椭圆形或圆形蒂部减张皮瓣改善逆行皮神经营养皮瓣转移后的血运，三角形瓣10例，圆形瓣8例，椭圆形瓣3例。手部软组织缺损5例，面积为5．0 cm×2．0 cm～8．0 cm×5．0 cm；足部、踝周及小腿下段软组织缺损16例，面积6．0 cm×4．0 cm～13．0 cm×7．0 cm；均伴有肌腱及骨骼等深部组织外露。采用足背皮神经营养皮瓣5例，腓浅神经营养血管皮瓣4例，腓肠神经营养血管皮瓣4例，隐神经营养血管皮瓣3例，桡神经浅支营养血管皮瓣2例，前臂外侧皮神经营养血管皮瓣3例，均为逆行转移。观察术后皮瓣成活，外观及感觉恢复情况。结果：1例逆行腓肠神经营养皮瓣远端坏死，经换药愈合，其余皮瓣全部成活，供区植皮均I期愈合。术后患者随访3个月～2年，平均7个月，皮瓣质地良好，外形平整美观，恢复痛温觉。结论：蒂部减张皮瓣能改善远端蒂皮神经营养血管皮瓣的血运，促进其成活，并改善修复创面外观。
목적：탐토3충불동형상체부감장판재피신경영양피판역행전이술중적응용급기료효。방법：자2006년1월지2012년1월，피판배사환자21례，남15례，녀6례；년령14～58세，평균35세；응용삼각형、타원형혹원형체부감장피판개선역행피신경영양피판전이후적혈운，삼각형판10례，원형판8례，타원형판3례。수부연조직결손5례，면적위5．0 cm×2．0 cm～8．0 cm×5．0 cm；족부、과주급소퇴하단연조직결손16례，면적6．0 cm×4．0 cm～13．0 cm×7．0 cm；균반유기건급골격등심부조직외로。채용족배피신경영양피판5례，비천신경영양혈관피판4례，비장신경영양혈관피판4례，은신경영양혈관피판3례，뇨신경천지영양혈관피판2례，전비외측피신경영양혈관피판3례，균위역행전이。관찰술후피판성활，외관급감각회복정황。결과：1례역행비장신경영양피판원단배사，경환약유합，기여피판전부성활，공구식피균I기유합。술후환자수방3개월～2년，평균7개월，피판질지량호，외형평정미관，회복통온각。결론：체부감장피판능개선원단체피신경영양혈관피판적혈운，촉진기성활，병개선수복창면외관。
Objective:To investigate the effects of the tension skin flap with different shapes on the transplantation of the reverse neurocutaneous island flap. Methods:From January 2006 to January 2012,there were 21 patients in the study (in-cluding 15 males and 6 females),and aged from 14 to 58 years old (35 years old on average). Tension skin flaps with different shapes (triangle,round and ellipse) were used to improve the blood supply of the reverse neurocutaneous island flap. The ten-sion skin flaps in the pedicle were designed triangularly (10 patients),spherically (8 patients) or elliptically (3 patients). There were 5 patients with defects in the hand (the size from 5.0 cm×2.0 cm to 8.0 cm×5.0 cm),and 16 patients with defects in the foot and inferior segment of leg,or around the ankle (the size from 6.0 cm×4.0 cm to 13.0 cm×7.0 cm). And all the patients were with the tendon and bone exposed. All the flaps were reversal transplanted ,including 5 dorsal neurocutaneous flaps of foot,4 superficial peroneal neurocutaneous flaps,4 saphenous neurocutaneous flaps,3 sural neurocutaneous flaps,2 superficial radial neurocutaneous flaps,3 lateral neurocutaneous flaps of forearm. And the survival rate,appearance and sensory recovery of the flaps were analyzed. Results:The distant part of the reversed sural neurocutaneous island flap in 1 case necrosized and healed after dressing change. The other flaps survived entirely ,and the donor site all healed primarily. The follow up time was from 3 months to 2 years (averaged 7 months),and all the flaps had recovered pain and warm sensation with perfect appear-ance. Conclusion:The tension skin flap in the pedicle can enhance the blood supply and promote survival rate of the reverse neurocutaneous island flap,and can also improve its appearance.