【摘要】 目的应用逆行皮神经营养血管筋膜蒂岛状皮瓣修复四肢肌腱、骨外露创面及皮瓣感觉重建。方法自1995年10月以来,应用该类型皮瓣修复手部创面20例,Ⅰ期邻近皮神经吻合皮瓣感觉重建10例,皮瓣面积最大17cm×12cm,最小8cm×7cm,蒂长2~5cm,宽4~5cm。修复膝、小腿及足部创面32例,皮瓣面积最大26·5cm×9cm,最小10cm×6cm,蒂长7~12cm,宽3~6cm。Ⅰ期邻近皮神经吻合皮瓣感觉重建12例。结果术后皮瓣完全成活48例,边缘部分坏死2例,完全坏死2例。经过3个月至2年的随访表明皮瓣感觉重建病例组感觉恢复S29例,S313例,较未吻合皮神经组的皮肤感觉有明显的差别。结论逆行皮神经营养血管筋膜蒂岛状皮血供可靠,不损伤肢体主要动脉。皮瓣所携带的皮神经与临近神经吻合可同时重建手掌及足底等重要部位的感觉功能,可作为四肢创伤皮肤缺损骨外露修复的首选皮瓣。更多还原

【Abstract】 Objective In order to applica te the island flap with the nutritional vessel of the cutaneous never to reconstru t the wound of the extremities and reconstrut the flap sensation.Methods Fifty-two cases with exposure of tendon abd bone including 20 upper l imbs and 32 lower limbs were treated with the flap area of forearm ranged from 8 cm×7cm to 17cm×12cm,and the ratio of the length to width of the flap was 1∶1 ～2.Thirty-two flap area of the calf ranged from 210cm×6cm to 10cm×6cm and th e ratio of the lengh to width of the pedicle was 2∶1.The rotatary angle was 130 °～170° in operation.The flap sensation of the 22 cases was reconstructed with skin never on posterior of the hand and foot.Results The flaps of 48 cases were survival completely.2 cases had partial necrosis on the margin .2 failure cases received cross-leg flap in the second operation.The patients w ere followed up with an average of 13.5 months(ranged from 3 months to 2 years). 22 cases of sensation reconstration were assessed by BMRC in which 9 cases were S2 and the others were S3.Conclusions The blood supply of t he island flap with the nutritional vessel of the cutaneous never is reliable.Th e type flap shoud be the first choice in the reconstrution of extremities wound. The flap senseation reconstrution is good for hand and food.更多还原