足部大面积皮肤软组织缺损的皮瓣修复临床分析足部大面积皮肤软组织缺损的皮瓣修复临床分析［摘要］目的：比较足部大面积皮肤软组织缺损应用不同类型皮瓣(小腿主干血管逆行皮瓣、皮神经营养血管逆行皮瓣和游离皮瓣)修复的临床效果。方法：57例足部大面积皮肤软组织缺损的患者清创后，应用不同类型的皮瓣进行修复,并比较其成活面积、观察其疗效。其屮，小腿主干血管逆行皮瓣14例，而积:7~9cmXll~20cm,平均:8cmX16cm,采用胫后动脉逆行皮瓣3例，腓动脉逆行皮瓣11例；皮神经营养血管逆行皮瓣26例，面积:7〜9cmX9〜15cm,平均:8cmXllcm,采用腓肠神经营养血管逆行岛状皮瓣23例，隐神经营养血管逆行岛状皮瓣3例;游离皮瓣17例，面积:9・5~15cmX12〜28cm,平均:12cmX25cm,采用股前外侧皮瓣13例，隐动脉皮瓣3例，胸背动脉皮瓣1例。结果：57例皮瓣中，完全坏死2例,部分坏死7例,其余全部成活。坏死者全部涉及前足皮肤缺损，其中，主干血管逆行皮瓣完全坏死1例，部分坏死2例;皮神经营养血管逆行皮瓣远端部分坏死5例;游离皮瓣完全坏死1例。统计学分析:皮瓣而积按类型比较(ANOVA),P=0.000,差异有非常显著性意义;皮瓣成活率按类型比较(Kruskal-WallisTest),P=0.455,差异无显著性意义。经3〜18个月随访,所有成活皮瓣血运、外形、质地、功能均满意。结论:大部分足部大面积皮肤软组织缺损可选用皮神经营养血管逆行皮瓣进行修复，但如果涉及前足，特别是缺损较大时，选择游离皮瓣更为适宜。［关键词］足部;皮肤缺损;皮瓣［］R622［文献标识码］A［文章编号］1008-6455(2010)01-0014-03ClinicalanalysisofrepairoflargeskindefectsinfeetwithflapsYANGYun-fa,ZHANGGuang-ming,XUZhong-he(DepartmentofOrthopedics,GuangzhouFirstMunicipalPeople,sHospital,GuangzhouMedicalCollege,Guangzhou510180,Guangdong,China)Abstract:ObjectiveToanalyzetheclinicaloutcomesofthreedifferenttypeflaps(retrogressiveflapsbasedontrunkvesselinleg,retrogressivecutaneousneurovascularislandflaps,andfreeflaps)forrepairoflargeskindefectsinfeet・MethodsAfterthoroughdebridement,57casesoflargeskindefectsinfeetwererepairedbythreedifferenttypeflaps,including14casesofretrogressiveflapsbasedontrunkvesselinlegwiththeaveragesurvivesizeof8cmX16cm(7~9cmX11〜20cm):3casesofretrogressiveflapsbasedonposteriortibialartery,11casesofretrogressiveflapsbasedonperonealartery;26casesofretrogressivecutaneousneurovascularislandflapswiththeaveragesurvivesizeof8cmX1lcm(7~9cmX9~15cm):23casesofdistalpediclesuralneurovascularislandflapsand3casesofdistalpediclesaphenousnerveneurovascularislandflaps;17casesoffreeskinflapswiththeaveragesurvivesizeof12cmX25cm(9.5~15cmX12~28cm):13casesoflateralthighflaps,3casesofarteriasaphenaflaps,and1caseofthoracodorsalarteryflap;andtheclinicaloutcomeswereobserved・ResultsAfter3to18monthsfollow-up,theflapssurvivedcompletelyrevealsufficientbloodsupply,goodshape,perfecttextureandsatisfactoryoutcomeexcluding2casesofcompletenecrosis(1caseoffreeskinflapandtheothercaseofretrogressiveflapsbasedontrunkvesselinleg)and7casesofdistalmarginalpartnecrosis(5casesofdistalpediclenerveneurovascularislandflapsand2casesofretrogressiveflapsbasedontrunkvesselinleg)・Accordingtoflaptypes,significantdifferencewasbetweensurvivesize(ANOVA,P二O.000),whilenodifferencebetweensurviveratio(Kruskal-WallisTest,P=0.455).ConclusionMostskindefectsoffeetcanbeeffectivelyrepairedbydistalpediclecutaneousneurovascularislandflaps,whileifthedefectsencroachedinforefeetespeciallywhenthedefectssizearecomparativelylarge,freeflapsshouldbestronglyrecommended・Keywords:feet;skindefects;flaps足部皮肤缺损在临床较为常见，由于其特定的功能和解剖特点，常合并骨、肌腱外露而难于愈合，常需要皮瓣修复[1],尤其是大...