CAJ | 학술논문

目的探讨应用腓动脉穿支蒂腓肠神经营养血管皮瓣修复下肢皮肤软组织缺损的手术方法及临床效果. 方法 2009年1月-2012年3月,笔者单位收治26例小腿下段及足部皮肤软组织缺损患者,其中车祸伤致小腿下段肌腱或骨外露9例,高压电击伤致足踝部皮肤坏死4例,小腿及足部慢性溃疡8例,足底压疮5例.彻底清创后,皮肤软组织缺损范围为11 cm×5 cm～18 cm×13 cm.根据缺损部位及大小设计切取腓动脉穿支蒂腓肠神经营养血管皮瓣,逆行转移修复皮肤软组织缺损.皮瓣切取面积12 cm ×6 cm ～20 cm× 15 cm.供瓣区直接拉拢缝合或植皮修复. 结果 25例皮瓣完全成活,1例皮瓣远端约2 cm×1 cm的区域坏死,经换药后愈合.随访6～12个月,皮瓣外形和局部感觉良好,无溃疡,行走正常. 结论腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作相对简便,血供可靠,蒂部臃肿不明显,能切取蒂部较长,皮瓣可切取面积较大,是修复小腿下段及足部皮肤软组织缺损的较佳方法.
목적 탐토응용비동맥천지체비장신경영양혈관피판수복하지피부연조직결손적수술방법급림상효과. 방법 2009년1월-2012년3월,필자단위수치26례소퇴하단급족부피부연조직결손환자,기중차화상치소퇴하단기건혹골외로9례,고압전격상치족과부피부배사4례,소퇴급족부만성궤양8례,족저압창5례.철저청창후,피부연조직결손범위위11 cm×5 cm～18 cm×13 cm.근거결손부위급대소설계절취비동맥천지체비장신경영양혈관피판,역행전이수복피부연조직결손.피판절취면적12 cm ×6 cm ～20 cm× 15 cm.공판구직접랍롱봉합혹식피수복. 결과 25례피판완전성활,1례피판원단약2 cm×1 cm적구역배사,경환약후유합.수방6～12개월,피판외형화국부감각량호,무궤양,행주정상. 결론 비동맥천지체비장신경영양혈관피판수술조작상대간편,혈공가고,체부옹종불명현,능절취체부교장,피판가절취면적교대,시수복소퇴하단급족부피부연조직결손적교가방법.
Objective To explore the operative technique and clinical results of using peroneal perforator-based sural neurofasciocutaneous flaps to repair skin and soft tissue defects in lower extremities.Methods From January 2009 to March 2012,26 patients with skin and soft tissue defects at distal region of leg and foot were hospitalized.Among them,9 patients suffered from tendon or bone exposure at the distal region of leg after injury due to traffic accident; 4 patients suffered from skin defects in the ankle as a result of electric injury; 8 patients suffered from chronic ulcer at the distal part of leg and foot; 5 patients suffered from plantar pressure ulcer.After debridement,soft tissue defect sizes ranged from 11 cm × 5 cm to 18 cm ×13 cm.According to the position and size of the defects,peroneal perforator-based sural neurofasciocutaneous flaps were designed and procured to repair the skin and soft tissue defects.The size of flaps ranged from 12 cm ×6 cm to 20 cm × 15 cm.Flap donor sites were closed by direct suture or skin grafting.Results Twenty-five flaps survived completely.Only one flap suffered partial margin necrosis in the size of 2 cm × 1 cm,which was healed after dressing change.Patients were followed up for 6 to 12 months.The appearance and sensation of flaps were satisfactory ; no ulcer occurred ; the movement of lower extremities was normal.Conclusions It is suitable to repair the skin and soft tissue defects at distal region of leg and foot with the peroneal perforator-based sural neurofasciocutaneous flap,as it possesses reliable blood supply,long and non-bulky pedicle,and sufficient available size.The operation is also easy to perform.