腓肠神经营养血管皮瓣修复儿童踝部组织缺损的可行性和预后

发布时间：2018-11-13 09:01

【摘要】：目的：腓肠神经营养血管皮瓣修复儿童踝部组织缺损的可行性和预后,展望可能的研究方向。方法：广泛查阅近年来有关腓肠神经营养血管皮瓣的基础研究及小腿腓肠神经营养血管皮瓣临床应用于修复足踝部软组织缺损的文献,选择常用的小腿腓肠神经营养血管皮瓣即腓肠神经营养血管筋膜蒂皮瓣修复儿童足踝部软组织缺损予以阐述,术前用多普勒仪探测穿支部位并标记。总计采集威海市威海卫人民医院骨科2006年11月～2013年7月就诊的儿童足踝部皮肤软组织缺损患者共37例。无任何感情倾向及暗示倾向,向患儿家长交代病情后及治疗方案后,对其中27例儿童足踝部软组织缺损采用小腿腓肠神经营养血管皮瓣修复。另取10例病例作为对照组,采用一期VSD负压吸引+二期游离植皮术。结果：转移皮瓣组病例术后皮瓣全部成活,无血管危象及感染发生,创面均Ⅰ期愈合,平均住院时间17天,均未施行再次手术,除12例伴有骨折的病人,其余患者均自行负重出院,踝关节活动范围好,术后随访3-6个月皮瓣颜色红润血运好,弹性及质地良好,皮瓣无色素沉着,外观好。对照组6例患者创面经两次手术后愈合,2例病人施行了3次手术,2例病人施行了4次手术,患者出院时均不能完全负重,踝关节活动范围受限,术后随访3-6个月皮肤均成活,3例因瘢痕组织导致弹性及质地差,3例踝关节活动范围仍受限,外观差。结论：小腿腓肠神经营养血管皮瓣手术设计灵活,对供区外形及功能影响小,是修复儿童足踝部软组织缺损较为理想的方法。提高小腿腓肠神经营养血管皮瓣轴心血管的定位,加强基础研究成果与临床应用的结合,根据足踝部不同软组织缺损的创面情况,选择合适大小的皮瓣,达到创面修复的最佳效果,将是今后的研究方向。
[Abstract]:Objective: to evaluate the feasibility and prognosis of sural neurovascular flap for the repair of ankle tissue defects in children. Methods: the basic research of sural neurovascular flap and the clinical application of sural neurovascular flap in repairing soft tissue defect of foot and ankle were reviewed extensively in recent years. The common sural neurovascular flap (sural nerve nutrient vascular fasciocutaneous flap) was used to repair the soft tissue defect of foot and ankle in children. The perforating branch was detected and labeled by Doppler instrument before operation. A total of 37 cases of foot and ankle skin and soft tissue defects in Department of Orthopaedics of Weihai people's Hospital of Weihai City were collected from November 2006 to July 2013. There was no emotional tendency or hint tendency. After explaining the condition to the parents and after the treatment, 27 cases of soft tissue defects of foot and ankle were repaired by sural neurovascular flap. Another 10 cases as control group were treated with primary VSD negative pressure suction and secondary free skin grafting. Results: in the flap transfer group, all the flap survived, no vascular crisis or infection occurred, the wound healed in the first stage, the average hospitalization time was 17 days, and no reoperation was performed, except for 12 patients with fracture. The rest of the patients were all discharged from hospital with a good range of ankle joint activities. The skin flap was followed up for 3 to 6 months. The skin flap had a good color, good elasticity and texture, no pigmentation and good appearance. In the control group, 6 cases of wound healed after two operations, 2 cases underwent 3 operations, 2 cases underwent 4 times of operation, all the patients were discharged from hospital without full load, and the range of ankle joint movement was limited. The skin survived for 3-6 months after operation, 3 cases had poor elasticity and texture due to scar tissue, and 3 cases had limited range of ankle joint motion and poor appearance. Conclusion: sural neurovascular flap is an ideal method for repairing soft tissue defect of foot and ankle in children because of its flexible design and little influence on the shape and function of donor area. To improve the cardiovascular location of sural neurovascular flap axis of the leg, to strengthen the combination of basic research results and clinical application, and to select the appropriate size flap according to the wound condition of different soft tissue defects in foot and ankle. To achieve the best effect of wound repair will be the research direction in the future.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R726.2

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