【摘要】 目的探讨远端蒂腓肠神经营养血管皮瓣修复跟腱区皮肤缺损的特点。方法应用远端蒂腓肠神经营养血管皮瓣修复跟腱区皮肤缺损44例,其中同时修复跟腱缺损20例;皮瓣长宽最小8 cm×4 cm,最大22 cm×10 cm,皮瓣旋转点位于外踝上5.0~7.9 cm者29例,8.0~10.9 cm者9例,11.0~15.0 cm者6例。结果术后皮瓣完全成活43例,完全成活率98%(43/44);远端部分坏死1例,再行内踝上皮瓣覆盖创面。伤口一期愈合39例,二期愈合5例;一期修复跟腱损伤与皮肤缺损的20例中,一期愈合18例,二期愈合2例。均术后随访1~42月,除1例伤口仍有渗液外,其余43例伤口愈合良好,无感染复发。结论远端蒂腓肠神经营养血管皮瓣血运佳、成活可靠、外形好、操作简单,是修复跟腱区皮肤缺损的理想皮瓣。更多还原

【Abstract】 Objective To explore the characteristics of reconstruction of skin defect overlying Achilles tendon using distally based sural neurovascular fasciocutaneous flap.Methods From January 2001 to January 2007,distally based sural neurovascular fasciocutaneous flap was used to resurface skin defect overlying Achilles tendon in 44 cases(42 patients),one-staged reconstruction of Achilles tendon rupture and skin defects were peformed in 20 patiemts;the dimension of the flap varied from 8 cm×4 cm to 22 cm×10 cm,The rotation points of the flaps located at 5.0 cm to 7.9 cm above the external malleolus in 29 cases,8.0 cm to 10.9 cm above the external malleolus in 9 cases,11.0 cm to 15.0 cm above the external malleolus in 6 cases.Results Forty-three of the 44 flaps survived uneventfully except for 1 flap had distal necrosis,and the flap was then given the superior internal malleolus flap to cover the wound.Among the 44 cases,thirty-nine cases underwent primary healing,secondary healing occurred in 5 cases.In the 20 patiemts who were peformed one-staged reconstruction of Achilles tendon rupture and skin defects using distally based sural neurovascular fasciocutaneous flap,fifteen cases underwent primary healing,five underwent secondary healing.Through 1 to 42 months following up,the results were satisfactory in 43 cases,except 1 flap had exudation.Conclusion Using the distally based sural neurovascular fasciocutaneous flap to reconstruct skin defect overlying Achilles tendon has the following merits: it features a reliable arterial supply and satisfactory venous return,the flap is cosmetically acceptable,and relatively easy and quick to raise during a one-stage procedure.The flap is an ideal option to repair soft tissue defect overlying Achilles tendon.更多还原