远端蒂腓肠神经营养血管皮瓣联合负压封闭吸引治疗足踝部软组织缺损

摘要

目的 探讨远端蒂腓肠神经营养血管皮瓣联合负压封闭吸引(VSD)技术治疗足踝部软组织缺损的临床效果.方法 2004年2月至2010年2月,26例足踝部软组织缺损(22 cm×10 cm至4 cm×3 cm)患者经急诊清创后持续应用VSD技术5～7 d,待创面条件改善后采用远端蒂腓肠神经营养血管皮瓣(24 cm×12 cm至6 cm×5 cm)覆盖,其中带肌皮瓣8例.结果 26例患者经VSD技术治疗后,创面肉芽组织生长良好;术后所有皮瓣均完全存活,创面一期愈合,无皮瓣坏死、感染及瘘道形成等并发症.术后随访6～18个月,皮瓣质地优良,外形与功能恢复满意.结论 远端蒂腓肠神经营养血管皮瓣联合VSD技术能有效控制足踝部局部感染,降低皮瓣坏死风险,提高创面修复成功率.%Objective To evaluate the outcome of the distally based sural neurofasciocutaneous flaps combined with vacuum sealing drainageCVSD) therapy for reconstruction of soft tissue defects of the foot and ankle. Methods From February 2004 to February 2010, 26 patients with soft tissue defects around the foot and ankle (ranged from 22 cm×10 cm to 4 cmX3 cm) were treated by debridement and the VSD therapy for 5 to 7 days, then the improved wounds were covered by the distal sural neurofasciocutaneous flaps (ranged from 24cm×12cm to 6cm×5 cm), including eight cases of fasriomyocutaneous flaps. Results After VSD material was removed, all 26 wounds were partially covered by healthy granulation tissue, and all the flaps survived completely without necrosis. No infection and fistula formation were observed. All the patients were satisfied with the aesthetic outcome postoperatively at 6 to 18 months* follow-up. Conclusion The methods of the distally based sural neurofasciocutaneous flap combined with VSD therapy could effectively control the local infection of the foot and ankle, reduce the risk of postoperative infection and improve success rate of wound reconstruction.