隐神经营养血管远端蒂岛状皮瓣在足踝部软组织缺损修复中的应用

发布时间：2018-05-06 14:53

本文选题：隐神经 + 皮瓣　；参考：《兰州大学》2015年硕士论文

【摘要】：目的：总结应用隐神经营养血管远端蒂岛状皮瓣转移修复足踝部软组织缺损修复中应用的临床效果。总结手术经验,依据皮瓣血供的解剖特点,使隐神经营养血管远端蒂岛状皮瓣切取转移的手术方式逐步完善成熟,同时总结提高隐神经营养血管远端蒂岛状皮瓣对足踝部软组织缺损修复的功能疗效。方法：对36例足踝部软组织缺损应用隐神经营养血管远端蒂岛状皮瓣转移修复,详细记录本组所有患者病因,以及足踝部损伤导致的局部缺损的创面部位、创面的大小范围和软组织缺损创面的深度、皮瓣选择及手术要求切取的范围大小、手术时隐神经、大隐静脉的外科处理方法、血管神经的吻合办法,蒂部转移手术处理技巧,以及术后患者恢复状况的随访。分析可能导致皮瓣坏死的原因,术后受区皮肤感觉感觉、皮瓣受区功能情况和患者自觉是否美观等相关因素。结合该皮瓣相关应用解剖和临床医学实践研究的科研成果,探讨隐神经营养血管远端蒂岛状皮瓣修复足踝部软组织缺损的手术方法及注意事项。结果：本组36例,男25例,女11例；年龄16-46岁,平均年龄28.5岁。均为创伤造成的足踝部软组织缺损致骨外露。其中单纯内踝区缺损者19例,足内侧区缺损9例,足跟内侧缺损4例,内外踝均缺损者4例。缺损面积为10.0×8.0cm～15.0×12.0cm。其中急诊修复14例,延期修复22例。本组所有患者中有3例患者皮瓣存活欠佳,边缘少量坏死,经过临床反复多次清创换药后创面愈合,其中1例术前局部存在严重感染的软组织缺损创面患者手术后第6天,皮瓣局部受区发生感染,拆除皮瓣周围部分缝线后充分引流感染灶,根据分泌物细菌实验室培养及药物敏感实验,选用合适的抗生素,经过临床反复多次清创换药后创面愈合；其余病例皮瓣转移均获得成功,术后甲级愈合、功能良好。本组患者随访周期6月～36月。本组所有患者皮瓣术后血供良好,皮瓣转移至受区后局部弹性佳,组织耐磨性强,患者自主感官满意,皮瓣术后随访未出现溃疡及局部皮肤严重瘢痕导致的挛缩,足踝部运动功能恢复满意。结论：隐神经营养血管远端蒂岛状皮瓣具有取材方便、解剖恒定、血供可靠、不牺牲主干血管、切取面积大,组织蒂长,旋转幅度大、覆盖能Ⅰ期完成等优点,也存在皮瓣显臃肿,术后局部瘢痕致外观不满意,牺牲一条感觉神经和大隐静脉,导致供区感觉缺乏或静脉回流障碍等不足,但总体来说,隐神经营养血管远端蒂岛状皮瓣转移修复足踝部软组织缺损,手术操作不复杂、效果肯定。
[Abstract]:Objective: to summarize the clinical effect of repairing soft tissue defect of foot and ankle with island flap pedicled with saphenous neurotrophic vessels. According to the anatomical characteristics of the blood supply of the skin flap, the surgical method of the island flap pedicled with the distal pedicle of the saphenous nerve nutrient vessel was gradually perfected and matured. At the same time, the functional effect of saphenous neurotrophic vessel distally pedicled island flap in repairing soft tissue defect of foot and ankle was summarized. Methods: 36 cases of soft tissue defect of foot and ankle were repaired with saphenous neurotrophic vessel pedicled island flap. The etiology of all patients and the site of local defect caused by injury of foot and ankle were recorded in detail. The size of the wound and the depth of the soft tissue defect, the selection of the flap and the scope of the operation requirements, the surgical treatment of the saphenous nerve, the great saphenous vein, the anastomosis of the blood vessel and nerve, the technique of surgical treatment of pedicle transfer, the surgical treatment of the saphenous nerve during the operation. And follow-up of postoperative patients recovery. To analyze the possible causes of skin necrosis, the sensation of the skin, the function of the flap and the beauty of the patients. Combined with the scientific research results of applied anatomy and clinical practice of the flap, the surgical methods and precautions of repairing soft tissue defect of foot and ankle with island flap with distal pedicle of saphenous neurotrophic vessels were discussed. Results: there were 36 cases (25 males and 11 females) aged 16-46 years with an average age of 28.5 years. All of them were bone exposure caused by soft tissue defect of foot and ankle. There were 19 cases of medial ankle defect, 9 cases of medial defect of foot, 4 cases of medial defect of heel and 4 cases of defect of medial and lateral malleolus. The defect area was 10.0 脳 8.0cm~15.0 脳 12.0cm. There were 14 cases of emergency repair and 22 cases of delayed repair. Three of the patients had poor skin flap survival and marginal necrosis. The wound healed after repeated debridement and dressing change. One patient with severe local infection had severe soft tissue defect wounds 6 days after operation. Infection occurred in the local area of the flap, and the infected foci were fully drained after removing some sutures around the flap. According to the laboratory culture of secretion bacteria and the drug sensitive experiment, the appropriate antibiotics were selected, and the wound healed after repeated debridement and dressing change. The other cases of flap transfer were successful, grade A healing, good function. The follow-up period was 6 months to 36 months. All the patients had good blood supply after operation, good local elasticity after flap transfer to the recipient area, strong tissue wear resistance, satisfactory autonomic senses, and no postoperative contracture caused by ulcers and severe scar of local skin. The motor function of foot and ankle recovered satisfactorily. Conclusion: the island flap with distal pedicle of saphenous neurotrophic vessels has the advantages of convenient sampling, constant anatomy, reliable blood supply, no sacrificing of main vessels, large cut area, long tissue pedicle, large rotation amplitude, and the ability to cover the first stage. There are also defects such as bloated skin flap, dissatisfactory appearance caused by local scar after operation, sacrificing a sensory nerve and great saphenous vein, resulting in a lack of feeling in the donor area or obstruction of venous reflux, etc., but generally speaking, The soft tissue defect of foot and ankle was repaired with island flap pedicled with distal saphenous neurotrophic vessel. The operation was not complicated and the effect was positive.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.3

【共引文献】