探讨腓肠神经营养血管皮瓣的临床应用和改良(1)
[摘要]目的 探讨腓肠神经营养血管逆行皮瓣的临床应用，并对手术方法进行归纳、总结、改良，进一步提高皮瓣的成活率。方法 选取2015年2月～2017年1月我院收治的60例临床创伤致前足背皮肤组织缺损患者，按照手术方法的不同分为观察组和对照组，每组30例。观察组应用改良腓肠神经营养血管皮瓣修复方法，对照组应用传统腓肠神经营养血管皮瓣修复方法，观察两组的临床疗效、创面愈合时间及并发症发生情况。结果 观察组的治疗总有效率为100.0%，高于对照组的86.7%，差异有统计学意义(P<0.05)。观察组的创面愈合时间显著短于对照组，差异有统计学意义(P<0.05)。观察组的并发症发生率为0.0%，低于对照组的16.7%，差异有统计学意义(P<0.05)。结论 腓肠神经营养血管皮瓣是修复前足背皮肤组织缺损伴肌腱、骨头、血管外露的理想方法，通过改良手术方法，更有利于皮瓣成活，恢复效果良好。
[关键词]腓肠神经；外科皮瓣；修复手术；皮肤组织缺损
[中图分类号] R658.2 [文献标识码] A [文章编号] 1674-4721(2017)12(a)-0019-04
[Abstract]Objective To explore the clinical application of sural neurovascular retrograde flap，to summarize and improve the surgical method，and to further improve the survival of the flap.Methods 60 cases of forefoot skin tissue defect caused by trauma from February 2015 to January 2017 in our hospital were selected as the subjects，according to the different surgical methods，all patients were divided into the observation group and the control group，30 cases in each group.The observation group was used modified sural neurovascular nutrition flap repair method，the control group was used traditional sural neurovascular nutrition flap repair method.The clinical efficacy，wound healing time and complications occurred were observed between the two groups.Results The total effective rate of the observation group was 100.0%，which was higher than 86.7% of the control group，the difference was statistically significant (P<0.05).The wound healing time of the observation group was significantly lower than that in the control group，with significant difference (P<0.05).The incidence of complications of the observation group was 0.0%，which was lower than 16.7% of the control group，the difference was statistically significant (P<0.05).Conclusion The sural neurovascular nutrition flap is an ideal method for repairing the defects of the forefoot skin tissue defect with the tendon，bone and blood vessels，it is more beneficial to the survival of the flap and improve the recovery effect through the improving surgical method.
[Key words]Sural nerve；Surgical flap；Repair surgery；Skin tissue defect
創伤造成的下肢皮肤缺损在临床上比较常见，以足背皮肤缺损最多，近年来其发病率呈逐年上升的趋势[1]。足背皮肤较薄，缺乏肌肉组织覆盖，若有开放性损伤一般伴有皮肤缺损，如果早期不能够消毒和皮肤覆盖，会导致肌腱坏死，严重者可能需要截肢[2]。腓肠神经营养血管皮瓣是修复下肢皮肤缺损的一种有效方法，而改良腓动脉终末穿支蒂腓肠神经营养血管皮瓣的效果更佳，能够大大提高皮瓣成活率。本研究选取我院收治的临床创伤致前足背皮肤组织缺损患者作为研究对象，应用改良腓肠神经营养血管皮瓣修复，取得了满意效果，现报道如下。
1资料与方法
1.1一般资料
选取我院2015年2月～2017年1月收治的60例临床创伤致前足背皮肤组织缺损患者作为研究对象，按照手术方法的不同分成观察组和对照组，每组30例。观察组中，男21例，女9例；年龄18～75岁，平均(30.25±5.66)岁；致伤原因：交通事故伤18例，术后感染5例，慢性溃疡7例；病程6 d～12个月，平均(3.07±0.24)个月；伴肌腱外露9例，骨头外露4例，血管外露12例。对照组中，男20例，女10例；年龄18～76岁，平均(30.51±5.49)岁；致伤原因：交通事故伤17例，术后感染7例，慢性溃疡6例；病程8 d～12个月，平均(3.11±0.26)个月；伴肌腱外露10例，骨头外露5例，血管外露10例。患者软组织缺损范围在3 cm×5 cm～6 cm×12 cm，排除严重心、肺、肝、肾等重要脏器病患以及静脉炎、凝血功能障碍患者。本研究经医院医学伦理学委员会批准，患者知情同意并签署知情同意书。两组患者的性别、年龄、致伤原因、病程等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(洪乔阳 陈剑锐 张学敏)
[关键词]腓肠神经；外科皮瓣；修复手术；皮肤组织缺损
[中图分类号] R658.2 [文献标识码] A [文章编号] 1674-4721(2017)12(a)-0019-04
[Abstract]Objective To explore the clinical application of sural neurovascular retrograde flap，to summarize and improve the surgical method，and to further improve the survival of the flap.Methods 60 cases of forefoot skin tissue defect caused by trauma from February 2015 to January 2017 in our hospital were selected as the subjects，according to the different surgical methods，all patients were divided into the observation group and the control group，30 cases in each group.The observation group was used modified sural neurovascular nutrition flap repair method，the control group was used traditional sural neurovascular nutrition flap repair method.The clinical efficacy，wound healing time and complications occurred were observed between the two groups.Results The total effective rate of the observation group was 100.0%，which was higher than 86.7% of the control group，the difference was statistically significant (P<0.05).The wound healing time of the observation group was significantly lower than that in the control group，with significant difference (P<0.05).The incidence of complications of the observation group was 0.0%，which was lower than 16.7% of the control group，the difference was statistically significant (P<0.05).Conclusion The sural neurovascular nutrition flap is an ideal method for repairing the defects of the forefoot skin tissue defect with the tendon，bone and blood vessels，it is more beneficial to the survival of the flap and improve the recovery effect through the improving surgical method.
[Key words]Sural nerve；Surgical flap；Repair surgery；Skin tissue defect
創伤造成的下肢皮肤缺损在临床上比较常见，以足背皮肤缺损最多，近年来其发病率呈逐年上升的趋势[1]。足背皮肤较薄，缺乏肌肉组织覆盖，若有开放性损伤一般伴有皮肤缺损，如果早期不能够消毒和皮肤覆盖，会导致肌腱坏死，严重者可能需要截肢[2]。腓肠神经营养血管皮瓣是修复下肢皮肤缺损的一种有效方法，而改良腓动脉终末穿支蒂腓肠神经营养血管皮瓣的效果更佳，能够大大提高皮瓣成活率。本研究选取我院收治的临床创伤致前足背皮肤组织缺损患者作为研究对象，应用改良腓肠神经营养血管皮瓣修复，取得了满意效果，现报道如下。
1资料与方法
1.1一般资料
选取我院2015年2月～2017年1月收治的60例临床创伤致前足背皮肤组织缺损患者作为研究对象，按照手术方法的不同分成观察组和对照组，每组30例。观察组中，男21例，女9例；年龄18～75岁，平均(30.25±5.66)岁；致伤原因：交通事故伤18例，术后感染5例，慢性溃疡7例；病程6 d～12个月，平均(3.07±0.24)个月；伴肌腱外露9例，骨头外露4例，血管外露12例。对照组中，男20例，女10例；年龄18～76岁，平均(30.51±5.49)岁；致伤原因：交通事故伤17例，术后感染7例，慢性溃疡6例；病程8 d～12个月，平均(3.11±0.26)个月；伴肌腱外露10例，骨头外露5例，血管外露10例。患者软组织缺损范围在3 cm×5 cm～6 cm×12 cm，排除严重心、肺、肝、肾等重要脏器病患以及静脉炎、凝血功能障碍患者。本研究经医院医学伦理学委员会批准，患者知情同意并签署知情同意书。两组患者的性别、年龄、致伤原因、病程等一般资料比较，差异无统计学意义(P>0.05)，具有可比性。, http://www.100md.com(洪乔阳 陈剑锐 张学敏)