Eisenschenk A, Noack N, Lautenbach M, Hartmann B, Küntscher M V
Abteilung für Hand-, Replantations- und Mikrochirurgie des Unfallkrankenhauses Berlin, Germany.
Z Orthop Ihre Grenzgeb. 2006 Sep-Oct;144(5):524-31. doi: 10.1055/s-2006-942263.
The purpose of the study was to establish an algorithm for the reconstruction of soft tissue defects of the distal lower leg, ankle and heel.
81 patients presenting with soft tissue defects in these regions underwent flap coverage. The average age was 44.1 years. Small defects (up to 4 x 4 cm) were covered by local flaps. The neurovascular sural flap was the predominant flap procedure for medium size defects (up to 10 x 15 cm). Free flaps were used for larger defects or in cases of stenosis or occlusion of the peroneal artery. Femoro-crural bypasses were performed in three cases to improve peripheral arterial perfusion.
The reconstructive goals were achieved in 95% of the cases by performing reconstruction according to the established algorithm. Minor complications occurred in 29.6% of the cases.
The results appear to be very good considering a patient population with complex and predominantly contaminated wounds. A preoperative angiography represents an important part of the algorithm for flap reconstruction to detect abnormal arterial vascular conditions and thus to plan vascular reconstruction prior to or simultaneously with free flap coverage. Additionally, a non-patency of the peroneal artery represents a contraindication for sural flaps.
本研究的目的是建立一种用于重建小腿远端、踝关节和足跟软组织缺损的算法。
81例这些部位出现软组织缺损的患者接受了皮瓣覆盖。平均年龄为44.1岁。小面积缺损（最大4×4厘米）采用局部皮瓣覆盖。对于中等面积缺损（最大10×15厘米），腓肠神经营养血管皮瓣是主要的皮瓣手术方式。对于较大缺损或腓动脉狭窄或闭塞的病例，则使用游离皮瓣。3例患者进行了股腘动脉搭桥术以改善外周动脉灌注。
按照既定算法进行重建，95%的病例实现了重建目标。29.6%的病例出现了轻微并发症。
考虑到患者群体伤口复杂且主要为污染伤口，结果似乎非常好。术前血管造影是皮瓣重建算法的重要组成部分，用于检测异常动脉血管情况，从而在游离皮瓣覆盖之前或同时规划血管重建。此外，腓动脉不通畅是腓肠神经营养血管皮瓣的禁忌证。
