CAJ | 학술논문

目的总结应用5种类型的带蒂皮瓣修复拇趾皮肤软组织缺损的临床效果及体会.方法 2008年1月至2013年6月,采用足背内侧皮神经营养血管皮瓣、足内侧皮神经营养血管皮瓣、跗外侧皮瓣、踝前侧皮瓣、交腿隐神经营养血管皮瓣逆行转移,对24例拇趾皮肤软组织缺损进行修复,皮肤缺损面积为3 cm ×2 cm～5 cm×3 cm,皮瓣面积为3.5 cm ×2.5 cm ～5.5 cm×4.0 cm.结果 1例足背内侧皮神经营养血管皮瓣远端小部分皮肤浅层发生坏死,1例足内侧皮神经营养血管皮瓣蒂部缝合较紧,出现静脉回流障碍,皮瓣远端1/3部分坏死,经换药后脱痂治愈,其余23例皮瓣未经特殊处理均顺利成活.15例患者获3 ～36个月的随访,正常行走步态无异常,皮瓣外形良好、无臃肿、耐磨、色泽与受区皮肤基本一致.吻合神经的8例中4例得到随访,皮瓣两点辨距觉为8～11 mm;未吻合神经者,由于受区神经的长入也产生了保护性感觉功能.结论针对不同类型的拇趾皮肤软组织缺损选择合适的皮瓣修复,不但拇趾长度得到了保留,而且也可获得较好的功能与外形.
목적 총결응용5충류형적대체피판수복무지피부연조직결손적림상효과급체회.방법 2008년1월지2013년6월,채용족배내측피신경영양혈관피판、족내측피신경영양혈관피판、부외측피판、과전측피판、교퇴은신경영양혈관피판역행전이,대24례무지피부연조직결손진행수복,피부결손면적위3 cm ×2 cm～5 cm×3 cm,피판면적위3.5 cm ×2.5 cm ～5.5 cm×4.0 cm.결과 1례족배내측피신경영양혈관피판원단소부분피부천층발생배사,1례족내측피신경영양혈관피판체부봉합교긴,출현정맥회류장애,피판원단1/3부분배사,경환약후탈가치유,기여23례피판미경특수처리균순리성활.15례환자획3 ～36개월적수방,정상행주보태무이상,피판외형량호、무옹종、내마、색택여수구피부기본일치.문합신경적8례중4례득도수방,피판량점변거각위8～11 mm;미문합신경자,유우수구신경적장입야산생료보호성감각공능.결론 침대불동류형적무지피부연조직결손선택합괄적피판수복,불단무지장도득도료보류,이차야가획득교호적공능여외형.
Objective To summarize the therapeutic effect of 5 kinds of flaps for the treatment of skin and soft tissue defect in the hallex.Methods From Jan.2008 to Jun.2013,24 cases with skin and soft tissue defects in the hallex were treated with 5 kinds of reversed flaps,including medial foot dorsal neurocutaneous flaps,medial foot neurocutaneous flaps,lateral tarsal flaps,anterior malleous flaps,medial cross leg and saphenous nerve flaps.The defects size ranged from 3 cm × 2 cm to 5 cm × 3 cm,with the flap size from 3.5 cm × 2.5 cm to 5.5 cm × 4.0 cm.Results Partial superficial necroisis happened at the distal end of one foot dorsal medial neurocutaneous flap.One third flap necrosis occurred in 1 foot medial neurocutaneous flap due to too tight suture at flap pedicle and resulted thrombosis.All the other 23 flaps survived completely.15 cases were followed up for 3-36 months with normal walking function and satisfactory appearance.Among the 8 cases with nerve anastomosis,4 cases were followed up with 2-point discrimination distance of 8-11 mm.the flaps without nerve anastomosis also had protective sense due to nerve ingrowth.Conclusions Skin and soft tissue defects in the hallex can be treated with different appropriate flaps.The hallex length can be reserved with satisfactory function and appearance.