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[1]贾 鹏,万春友,舒衡生,等. 外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移治疗足跟软组织缺损[J].天津医科大学学报,2015,21(02):143-146.
　JIA Peng,WAN Chun-you,SHU Heng-sheng,et al. Reversed sural neurocutaneous island flap combined with external fixation to repair the soft tissue defect in the heelstick[J].Journal of Tianjin Medical University,2015,21(02):143-146.
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 外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移治疗足跟软组织缺损(PDF)
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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
21卷
期数:
2015年02期
页码:
143-146
栏目:
临床医学
出版日期:
2015-03-20

文章信息/Info

Title:
 Reversed sural neurocutaneous island flap combined with external fixation to repair the soft tissue defect in the heelstick
文章编号:
1006-8147（2015）02-0143-04
作者:
 贾 鹏1; 2; 万春友2; 舒衡生2; 王 凯3
 (1．天津医科大学研究生院，天津300070; 2. 天津市天津医院骨科，天津300211; 3. 天津医科大学第二医院骨科，天津300211)
Author(s):
JIA Peng1; 2; WAN Chun-you2; SHU Heng-sheng2; WANG Kai3
 (1．Graduate School, Tianjin Medical University ，Tianjin 300070，China; 2. Department of Orthopedics,，Tianjin Hospital, Tianjin 300211,China; 3. Department of Orthopedics ，The Second Hospital, Tianjin Medical University ,Tianjin 300211,China）
关键词:
 ; 腓肠神经; 皮瓣; 外固定支架; 足跟; 缺损
Keywords:
sural nerve;  flap;  external fixation;  heelstick;  defect

分类号:
R68
DOI:
-
文献标志码:
A
摘要:
目的：探讨外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移治疗足跟软组织缺损的疗效。方法： 应用组合式外固定支架及Ilizarov外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移术修复足跟皮肤缺损16例。患者年龄18～65岁；合并同侧跟骨骨折者7例，同侧足部多发骨折脱位者3例，同侧胫腓骨远端骨折者3例。所有病例均伴随不同程度的窦道形成、骨外露、周围贴骨瘢痕形成，缺损面积3 cmx5 cm～10 cmx8 cm。受伤距手术时间1.5~121个月。术前常规行创面分泌物细菌培养和药敏试验，术中彻底清创，再行腓肠神经营养血管逆行岛状皮瓣转移（皮瓣面积4 cmx6 cm～12 cmx9cm ），最后根据合并伤的不同选择适合的外固定支架固定。结果：所有病例均获得随访，随访时间5～36个月，平均12个月，16例皮瓣全部成活，皮瓣质地优良，耐磨，无明显挛缩，负重功能区未发生破溃及感染坏死。踝关节背伸0°～20°，跖屈30°～40°。结论：应用外固定支架结合腓肠神经营养血管逆行岛状皮瓣转移术治疗足跟软组织缺损，有利于皮瓣的成活和肢体功能的改善，能同时治疗足部骨折和矫正马蹄足畸形，可获得满意的临床疗效。
Abstract:
Objective: To investigate the clinical effect of the reversed sural neurocutaneous island flap combined with external fixation to repair the soft tissue defect in the heelstick. Methods: Sixteen cases of the heelstick soft tissue defects were treated with the reversed sural neurocutaneous island flap combined with external fixation. Eleven males and 5 females with an average age of 45.3 years (18-65 years) were given the treatment, including 5 cases with calcaneal fractures, 3 cases with multiple fractures with the dislocation in foot, and 3 cases with the distal tibial and fibular fractures. All patients had sinus, bone exposure and stick bone scar. The size of defect area was from 3 cmx5 cm-10 cmx8 cm. The injuries occurred 1.5 to 121 months after the surgery. The wound secretion bacteria cultures and drug sensitive test were performed on all patients before operation and thorough debridement, then the reversed sural neurocutaneous island flap was applied（area of flap 4 cmx6 cm～12 cmx9cm）. Finally, the adaptive external fixation according to associated injuries was used in operation. Results: All patients were followed up for 5 to 36 months, and the mean follow-up period was 12 months. The flaps of 16 cases all survived. All flaps were fine quality, Wear-resisting, without obvious contracture, no ulcer, infection or necrosis occurred in the weight area. The function of ankles were good, with the dorsal extension of 0° to 20°and the plantar flexion of 30° to 40°. Conclusion: The reversed sural neurocutaneous island flap combined with external fixation can improve the limb function and the flap survival with good clinical effect.

参考文献/References:

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[4] Suzuki T, Minehara A, Matsuura T，et al . Negative-pressure wound therapy over surgically closed wounds in open fractures[J]. J Orthop Surg , 2014, 22(1): 30

[5]Masquelet A C, Romana M C, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992, 89(6): 1115

[6]钟世镇．显微外科解剖学[M]．北京：人民卫生出版社，1984：36-36

[7]柴益民，林崇正，陈彦堃，等．吻合小隐静脉的腓肠神经营养血管逆行皮瓣的应用[J]．中华显微外科杂志，2000（2）：74

[8]Roukis T S, Landsman A S, Weinberg S A, et al. Use of a hybrid "kickstand" external fixator for pressure relief after soft-tissue Reconstruction of heel defects[J]. J Foot Ankle Surg, 2003, 42(4): 240

[9]Clark J, Joseph L M, Armstrong D G. A method of external fixation to of?oad and protect the foot following Reconstruction in High-Risk patients:the SALSAstand[J]. Eplasty. 2009 ，9:e21

[10]Lowenberg D W, Sadeghi C, Brooks D, et al. Use of circular external fixation to maintain foot position during free tissue transfer to the foot and ankle[J]. Microsurgery, 2008, 28(8): 623

[11]张发惠，林松庆，郑和平，等．腓肠神经营养血管远端蒂皮瓣小隐静脉的应用解剖[J]．中国修复重建外科杂志，2005，19（7）：505

[12]曾宪铁，舒衡生，王宏川，等．撬拨复位结合Ilizarov技术治疗跟骨关节内骨折[J]．中华创伤杂志，2011，25（6）：537

[13]Bibbo C. Reverse sural flap with bifocal ilizarov technique for tibial osteomyelitis with bone and soft tissue defects[J]. J Foot Ankle Surg, 2014, 53(3): 344

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备注/Memo

备注/Memo:
作者简介 贾鹏（1979-），男， 主治医师，学士 ,研究方向：创伤骨科;

通信作者：王凯， E-mail:wangkaiy48@126.com。





更新日期/Last Update: 2015-03-24