【摘要】 目的:介绍健侧腓肠肌外侧头肌皮瓣治疗对侧足跟外侧深部溃疡的经验,确定手术适应征并对本方法治疗的结果进行评估。方法:两年间21例患者接受该方法治疗,其中男18例,女3例。致伤原因以车祸和跟骨骨折内固定术后感染为主。该手术采用健侧腓肠肌外侧头为供区制备成带血管蒂肌皮瓣。逐渐彻底清除足跟外侧的溃烂坏死组织,一次性转植患侧足跟外侧的溃疡部位。术后交腿石膏外固定于“翘二郎腿”状。常规换药抗炎治疗,每天观察肌皮瓣血供情况,三周后经过闭蒂、断蒂肌皮瓣成活。结果:21例均成活。Ⅱ类甲级愈合18例,轻度感染3例,肌皮瓣远端小范围皮缘坏死3例。术后平均住院时间31d。结论:该手术治疗适应于患侧软组织损伤严重、血管条件差无法进行吻合血管肌皮瓣转移的病例。交腿肌皮瓣因带有血管蒂具有较强的抗感染能力、和成活能力。能迅速填充溃疡部位并快速愈合,是治疗足跟外侧深部溃疡的较好的方法之一。更多还原

【Abstract】 Objective: The purpose of this paper is to introduce the experience of the treatment to the deep ulcer in the lateral part of heel with the lateral head of unaffected gastrocnemius muscular cutaneous flap, to confirm the indications of the operation and to evaluate the outcomes of the treatment.Methods: There were 21 patients including 18 males and 3 females who were cared by this kind of treatment in two years. The causes of their disease were mainly traffic injury or infection after the open reduction and internal fixation for the fracture of calcaneus. In the operation the lateral head of unaffected gastrocnemius which was as a donor was made up into a sort of muscular cutaneous pedicle flap with blood vessel. Then the flap was embedded into the deep ulcer in the lateral part of heel one time when the erosion and necrosis tissues in the ulcer being once cleared away. After the operation two legs were in plaster fixation with the shape of crossing knees. And changing the sterile gauzes of the wound and anti-inflammatory were all normally done. While at the same time it was necessary to observe the blood fluency of the flap. By the third week after the sequenced process of clamping and cutting the pedicle of the flap, the operation was succeeding.Results: The total of 21 flaps were survival of which 18 cases scored first grade of Ⅱ, 3 cases got slight infection and 3 cases showed necrosis in the small margin of the distal flaps. Average post-operative admission day was 31. Conclusion: It is the indication which there has not chance to be treated by the island muscular cutaneous flap of the affected leg. And the crossing legs flaps consist of the stronger abilities to anti-inflammatory and to survive which could rapidly full-fill the ulcer and quickly healing. That is one of the better treatments to the deep ulcer in the lateral part of heel.更多还原