CAJ | 학술논문

目的探讨不同类型皮瓣修复高能量损伤致足跟软组织缺损的方法及疗效.方法选择2002年1月-2012年6月收治的足跟软组织缺损患者21例,其中男12例,女9例;年龄18 ～57岁,平均32岁.致伤原因:交通伤11例,机器绞伤10例.足跟部软组织缺损范围为5 cm×3 cm～8 cm×6cm.以腓肠神经营养血管皮瓣修复足跟后外侧创面9例(A组),以胫后动脉皮瓣修复足跟后外侧创面5例(B组),以足底内侧皮瓣修复足跟底部负重区创面7例(C组).比较三组术后12个月感觉恢复、两点辨别觉,视觉模拟评分(VAS)及关节活动度.结果 21例皮瓣均完全成活,1例皮瓣远端表皮坏死,经局部换药后痊愈,未再次手术.术后随访12～24个月,成活皮瓣外观、质地和厚度与足跟部受区相似,负重区无溃疡发生,有保护性感觉,正常步态行走.术后12个月A、B、C三组皮瓣感觉恢复率分别为0、20％、100％(P＜0.01).三组足跟部外形基本正常,A组8例(89％)、B组4例(80％)、C组6例(86％)可不负重无痛行走,组间比较差异无统计学意义(P＞0.05).但负重行走时患足均伴不同程度疼痛,VAS组间比较差异均有统计学意义(P＜0.05),患侧踝关节活动度组间比较差异无统计学意义(P＞0.05).结论长度5～8 cm的足跟负重区创面宜选择足底内侧皮瓣修复,对于长度＞8 cm的足跟负重区或非负重区创面,采用逆行腓肠神经营养血管皮瓣或胫后动脉皮瓣为宜,从而提高皮瓣成活率并重建肢体功能.
목적 탐토불동류형피판수복고능량손상치족근연조직결손적방법급료효.방법 선택2002년1월-2012년6월수치적족근연조직결손환자21례,기중남12례,녀9례;년령18 ～57세,평균32세.치상원인:교통상11례,궤기교상10례.족근부연조직결손범위위5 cm×3 cm～8 cm×6cm.이비장신경영양혈관피판수복족근후외측창면9례(A조),이경후동맥피판수복족근후외측창면5례(B조),이족저내측피판수복족근저부부중구창면7례(C조).비교삼조술후12개월감각회복、량점변별각,시각모의평분(VAS)급관절활동도.결과 21례피판균완전성활,1례피판원단표피배사,경국부환약후전유,미재차수술.술후수방12～24개월,성활피판외관、질지화후도여족근부수구상사,부중구무궤양발생,유보호성감각,정상보태행주.술후12개월A、B、C삼조피판감각회복솔분별위0、20％、100％(P＜0.01).삼조족근부외형기본정상,A조8례(89％)、B조4례(80％)、C조6례(86％)가불부중무통행주,조간비교차이무통계학의의(P＞0.05).단부중행주시환족균반불동정도동통,VAS조간비교차이균유통계학의의(P＜0.05),환측과관절활동도조간비교차이무통계학의의(P＞0.05).결론 장도5～8 cm적족근부중구창면의선택족저내측피판수복,대우장도＞8 cm적족근부중구혹비부중구창면,채용역행비장신경영양혈관피판혹경후동맥피판위의,종이제고피판성활솔병중건지체공능.
Objective To investigate the methods and effects of different flaps for repair of high energy injury-induced soft tissue wound of the heel.Methods From January 2002 to June 2012,the patients including 12 males and 9 females aged 18-57 years (mean,32 years) underwent heel soft tissue defect reconstruction.Causes of injury were traffic injury in 11 case and mechanical injury in 10 cases.Dimension of soft tissue defect ranged from 5 cm × 3 cm to 8 cm × 6 cm.Soft-tissue defect was repaired with sural neurovascular flaps at the posterolateral heel in 9 cases (Group A),with posterior tibial artery flaps at the posterolateral heel in 5 cases (Group B),and with medial plantar flaps at the loading area of heel in 7 cases (Group C).Sensory recovery and two point discrimination motion of the ankle joint were observed and compared among groups 12 month after operation.Heel pain was observed during weight bearing and joint activity was evaluated using the visual analogue scale (VAS).Results All the flaps survived,except for one with epidermal necrosis over the distal part,which healed after partial changing medication.Duration of follow-up was 12-24 months.There were no differences in the appearance,texture and contour between the flaps and recipient sites.Flaps showed no ulcer in the weight-bearing area and recovered their protective sense.Patients could walk normally after surgery.At postoperative 1 year,sensory recovery rate of the flaps in Groups A,B and C was 0,20％ and 100％ respectively (P ＜0.01).Appearance of the heel in all groups recovered to almost normal.Cases that could start nil weight-bearing exercise without pain accounted for 8 (89％) in Group A,4 (80％) in Group B,and 6 (86％) in Group C (P ＞ 0.05).While heel pain existed in weight-bearing exercise.Difference in VAS was significant among the three groups (P ＜ 0.05),but ankle range of motion was not (P ＞0.05).Conclusion Medial plantar flaps are suitable for tissue defect of 5-8 cm in length but sural neurovascular flaps and posterior tibial artery flaps should be considered for over 8 cm defect in order to elevate survival rate of the flaps and reconstruct limb function.