尚耀华,
张铁慧,
杨文峰,
钟声,
徐连春,
董玉金^,
大连医科大学附属大连市中心医院 手足外科, 辽宁 大连 116033

详细信息 作者简介: 尚耀华(1982-), 男, 主治医师。E-mail: 15566975670@163.com






通讯作者: 董玉金, 主任医师。E-mail: wxm_781121@163.com 中图分类号: R641


摘要:目的探讨腓肠神经小隐静脉营养血管的小腿梨形皮瓣在修复和治疗小腿及足部皮肤软组织损伤中的可行性及临床疗效。方法收集2015—2019年在大连市中心医院手足外科就诊的小腿远端及足部皮肤软组织大面积损伤37例患者的临床资料。其中车祸伤11例，重物砸伤6例，电锯伤8例，机械绞伤5例，糖尿病足7例。创面缺损面积3.0 cm×5.0 cm~9.0 cm×15.0 cm。根据患者的损伤部位、面积和软组织受损程度，采用不同面积大小的小腿皮瓣进行创面修复，并通过术后皮瓣成活情况、Maryland足功能评分及BMRC感觉功能评分，对皮瓣及肢体功能恢复情况进行评价。结果本组35例皮瓣成活，1例术后10天皮瓣感染并坏死，后经封闭式负压引流（vacuum sealing draina，VSD）术清创及足底内侧皮瓣修复后创面愈合，1例因严重糖尿病并发坏疽，于术后2月截肢。术后3个月根据Maryland足功能学评分判定，皮瓣恢复优19例，良12例，可4例，失败2例，优良率为83.8%；BMRC皮瓣感觉功能评分S₃~S₄为22例，S₂为11例，S₁为2例，供区肢体未见明显瘢痕、局部挛缩或功能障碍。结论小腿腓肠神经小隐静脉营养血管倒梨形皮瓣，可以有效修复小腿及足部创面，恢复感觉及运动功能，提高患者生活质量，值得临床推广。
关键词: 下肢皮肤软组织损伤/
梨形皮瓣/
创伤修复/
皮瓣移植


Abstract:ObjectiveTo explore the clinical feasibility and curative effect of calf pear-shaped skin flap with nutrient vessel of sural nerve and small saphenous vein in repairing and treating calf and foot skin and soft tissue injuries.MethodsTotally 37 patients (27 males and 10 females) with extensive skin and soft tissue injury in the distal leg and foot, who were treated in the Department of Hand and Foot Surgery of my hospital from 2015 to 2019, were enrolled in this study. There were 11 cases of traffic accident injury, 6 cases of heavy object injury, 8 cases of saw injury, 5 cases of mechanical strangulation and 7 cases of diabetic foot. The area of wound ranged from 3.0 cm×5.0 cm to 9.0 cm×15.0 cm. According to the site, area and degree of soft tissue injury, leg flaps of different sizes were used for the wound repair. Functional recovery of the flaps and limbs was evaluated by the survival of the flaps, Maryland foot function score and BMRC sensory function score.ResultsAfter 5-12 months of follow-up, the skip flaps survived in 35 patients. One patient had flap infection and necrosis although the wound healed after VSD debridement and repair of medial plantar flap. One patient with severe diabetes mellitus was complicated with gangrene and amputated two months after surgery. According to Maryland foot function score, the skip flaps in 19 cases were excellent, 12 cases good, 4 cases fair and 2 cases failure; the excellent and good rate was 83.8%. The BMRC sensory function scores of the flaps were S₃-S₄ in 22 cases, S₂ in 11 cases, and S₁ in 2 cases. No obvious scar, local contracture or dysfunction was found in the donor limbs.ConclusionsThe reverse piriform flap with nutrient vessels of sural nerve saphenous vein can effectively repair the wounds of leg and foot, restore sensory and motor functions, improve the quality of life of patients, and thus is worthy of clinical promotion.
Keywords:lower limb skin and soft tissue injury/
pear shaped skin flap/
wound repair/
skin flap transplantation

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