Mozafari Naser, Moosavizadeh S Mehdi, Rasti Mehdi
Plastic and Reconstructive Surgery, Shahid Beheshti Medical University, 15 Khordad Hospital, Iran.
Burns. 2008 May;34(3):406-11. doi: 10.1016/j.burns.2007.04.008. Epub 2007 Sep 11.
Debridment of fourth degree burn wound usually leads to soft tissue loss. If these wound are on distal one-third of lower leg and ankle, a simple wound changes to a complex problem. Options are available for these conditions, but each of them have advantages and disadvantages. The distally based neurocutaneous sural flap is one recent flap available for this problem which has excellent results and decreased disadvantages.
Between 2000 and 2004, all patients with acute fourth degree burns or unstable scar on the distal third of lower leg, foot or ankle that referred to our hospital were scheduled for reconstruction by sural flap. The success rate and ability of the flap to create stable durable coverage at these sites were evaluated.
Fifteen patients from 1.5 to 75 years old were included to this study. We had excellent result with this type of flap in 14, we had 100% success rate without necrosis. Only in one patient (a 75 years old man with a history of diabetes mellitus) we had a 0.5cm necrosis of distal margin of flap which healed completely after one session of debridement. All patients were completely satisfied with this flap.
Because of few drawbacks of this flap and high success rate and relative simple operative technique, we recommend sural flap as a prime option for repair of fourth degree burn, at distal leg, foot and ankle.
四度烧伤创面的清创通常会导致软组织缺损。如果这些创面位于小腿和踝关节的远侧三分之一处，一个简单的创面就会变成一个复杂的问题。针对这些情况有多种选择，但每种选择都有优缺点。带蒂腓肠神经营养皮瓣是最近用于解决这一问题的一种皮瓣，效果极佳且缺点较少。
2000年至2004年期间，所有因小腿远侧三分之一、足部或踝关节急性四度烧伤或瘢痕不稳定而转诊至我院的患者均计划采用腓肠皮瓣进行重建。评估了皮瓣在这些部位实现稳定持久覆盖的成功率和能力。
15例年龄在1.5岁至75岁之间的患者纳入本研究。我们使用这种皮瓣取得了极佳的效果，14例效果良好，成功率达100%，无坏死情况。仅1例患者（一名75岁有糖尿病史的男性）皮瓣远侧边缘出现0.5cm坏死，经一次清创后完全愈合。所有患者对该皮瓣都非常满意。
由于这种皮瓣缺点较少、成功率高且手术技术相对简单，我们推荐腓肠皮瓣作为修复小腿远侧、足部和踝关节四度烧伤的首选方案。
