CAJ | 학술논문

目的探讨主穿支供血型小腿皮神经营养血管皮瓣一期修复小腿及足踝部创面的方法及效果.方法回顾性分析2003年7月至2011年2月,对收治的39例高能损伤导致的小腿及足踝部损伤,单独或组合选择腓动脉主穿支供血游离或穿支蒂腓肠神经营养血管皮瓣、外踝上穿支蒂腓浅神经营养血管皮瓣、胫后动脉主穿支供血游离或穿支蒂隐神经营养血管皮瓣进行一期修复.结果 39例44处创面,采用腓动脉主穿支供血腓肠神经营养血管皮瓣32块(穿支蒂27块、游离5块),胫后动脉主穿支供血隐神经营养血管皮瓣6块(穿支蒂5块、游离1块),外踝上穿支蒂腓浅神经营养血管皮瓣6块,最大切取面积22 cm×10 cm.术后皮瓣均全部成活,平均住院23 d(12～36 d).术后随访6～15个月,皮瓣质地优良,外形与足踝功能恢复满意,吻合神经者两点辨距觉2.5～5 cm,未吻合神经者术后1年以上均存在保护性感觉.结论上述3种主穿支皮神经营养血管皮瓣血供确切,合理个体化选择应用可修复不同类型小腿及足踝部创面；一期修复解剖清晰、血管条件好、手术设计灵活,可减少感染机会及肉芽瘢痕,利于功能恢复并缩短治疗周期.
목적 탐토주천지공혈형소퇴피신경영양혈관피판일기수복소퇴급족과부창면적방법급효과.방법 회고성분석2003년7월지2011년2월,대수치적39례고능손상도치적소퇴급족과부손상,단독혹조합선택비동맥주천지공혈유리혹천지체비장신경영양혈관피판、외과상천지체비천신경영양혈관피판、경후동맥주천지공혈유리혹천지체은신경영양혈관피판진행일기수복.결과 39례44처창면,채용비동맥주천지공혈비장신경영양혈관피판32괴(천지체27괴、유리5괴),경후동맥주천지공혈은신경영양혈관피판6괴(천지체5괴、유리1괴),외과상천지체비천신경영양혈관피판6괴,최대절취면적22 cm×10 cm.술후피판균전부성활,평균주원23 d(12～36 d).술후수방6～15개월,피판질지우량,외형여족과공능회복만의,문합신경자량점변거각2.5～5 cm,미문합신경자술후1년이상균존재보호성감각.결론 상술3충주천지피신경영양혈관피판혈공학절,합리개체화선택응용가수복불동류형소퇴급족과부창면；일기수복해부청석、혈관조건호、수술설계령활,가감소감염궤회급육아반흔,리우공능회복병축단치료주기.
Objective To evaluate the therapeutic effect of donimant perforator neurocutaneous flaps for one-staged reconstruction of defects caused by high energy at lower legs,ankles and feet.Methods From July 2003 to Feb.2011,39 cases,with defects caused by high energy at lower legs,ankles and feet,were retrospectively studied.The defects were covered primarily by one or two perforator neurocutaneous flaps(free or pedicled) which were based on a dominant perforator arising from the posterior tibial or peroneal artery (including the lateral superamalleolar perforating artery which is also from the peroneal vessel) respectively through sural,saphenous and superficial peroneal nerocutaneous vascular axis.Results 39 cases with 44 defects were treated by 32 sural neurocutaneous flaps based on the peroneal perforator (5 free and 27 pedicled),6 saphenous neurocutaneous flaps on the posterior tibial perforator(1 free and 5 pedicled) and 6 superficial peroneal ones on the lateral superamalleolar perforating artery.The largest flap size was 22 cm × 10 cm.All flaps were survived successfully without necrosis.The average in-hospital time was 23 days (ranged from 12-36 days).Conclusions The three kinds of dominant perforator neurocutaneous flaps have reliable blood supply with a relatively large size.They can be chosen and designed individually for all kinds of defects over the lower leg,ankle and foot.There are many advantages in a primary procedure,such as easier dissection,better vessel status in or around recipient areas,less secondary necrosis and lower risk of chronic infection.Moreover,the reduction of granulation and scar tissues benefit functional rehabilitation.