CAJ | 학술논문

目的：总结负压封闭引流(vacuum sealing drainage, VSD)技术联合腓肠神经营养血管皮瓣治疗足踝部感染性创面的临床疗效。方法2008年1月—2013年6月，采用腓肠神经营养血管皮瓣修复足踝部感染性创面18例，其中修复足跟部骨髓炎4例，足踝部软组织感染性创面14例。本组病例均采用一期彻底清创后VSD技术处理创面，二期应用腓肠神经营养血管皮瓣修复缺损创面。术中对跟骨骨髓炎患者切取带有部分腓肠肌的肌皮瓣修复，其余均采用筋膜皮瓣修复。皮瓣切取面积：5.0 cm×8.0 cm～13.0 cm×15.0 cm。结果18例皮瓣中16例生长良好，感染治愈，伤口一期愈合；1例糖尿病足患者皮瓣远端浅表坏死，经换药后植皮愈合；1例跟骨骨髓炎患者术后皮瓣血运良好，但伤口持续流脓，最终皮瓣坏死，经彻底清创、跟骨死腔内填塞抗生素骨水泥、游离皮瓣移植修复愈合。术后经6～24个月随访，皮瓣质地良好，厚薄均匀，色泽与周边皮肤相似，恢复保护性感觉，下肢负重、行走基本正常。结论 VSD技术联合腓肠神经营养血管皮瓣治疗足踝部感染性创面可获得较好的临床疗效。
목적：총결부압봉폐인류(vacuum sealing drainage, VSD)기술연합비장신경영양혈관피판치료족과부감염성창면적림상료효。방법2008년1월—2013년6월，채용비장신경영양혈관피판수복족과부감염성창면18례，기중수복족근부골수염4례，족과부연조직감염성창면14례。본조병례균채용일기철저청창후VSD기술처리창면，이기응용비장신경영양혈관피판수복결손창면。술중대근골골수염환자절취대유부분비장기적기피판수복，기여균채용근막피판수복。피판절취면적：5.0 cm×8.0 cm～13.0 cm×15.0 cm。결과18례피판중16례생장량호，감염치유，상구일기유합；1례당뇨병족환자피판원단천표배사，경환약후식피유합；1례근골골수염환자술후피판혈운량호，단상구지속류농，최종피판배사，경철저청창、근골사강내전새항생소골수니、유리피판이식수복유합。술후경6～24개월수방，피판질지량호，후박균균，색택여주변피부상사，회복보호성감각，하지부중、행주기본정상。결론 VSD기술연합비장신경영양혈관피판치료족과부감염성창면가획득교호적림상료효。
Objective To study the results of the vacuum sealing drainage technique combined with sural neurovascular pedicle fascio-cutaneous flap to repair infectious wounds in the foot or ankle. Methods From January 2008 to June 2013, 18 cases with infectious wounds in the foot or ankle were treated by the sural neurovascular pedicle fascio-cutaneous flap. Among the 18 case, 4 cases were foot heel osteomyelitis and 14 cases were the infective wound of soft tissue in ankle. All cases were treated by VSD in first stage and repaired by sural neurovasculr pedicle fascio-cutaneous flap in next stage. Patients with osteomyelitis were repaired by myocutaneous flap, and the rest were repaired by fascia flap. Size of flaps varied from 5.0 cm ×8.0 cm to 13.0 cm ×15.0 cm. Results 16 cases survived. One case suffered superficial necrosis which was diabetic foot flap and healed after applying the skin graft. In another case with calcaneal osteomyelitis, flap blood supply is good, but the wound was continuous discharging and flap was necrosis finally. The case was treated by radical debridement and antibiotics bone cement tamponade, and healed by free flap trans-plantation eventually. These cases were followed-up for 6 months to 2 years and got satisfactory colour, apperence and protective feeling. Conclusion VSD technique combined with sural neurovascular pedicle fascio-cutaneous flap to repair infectious wounds in the foot or ankle can obtain good clinical effect.