Zheng Jinwen, Cen Shiqiang, Huang Fuguo
Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Nov;21(11):1209-12.
To summarize the clinical effects of the repairing methods for deep wounds of the foot and ankle.
From March 2002 to June 2006, 49 patients with skin and deep tissue defects of the foot and ankle underwent the repairing treatment. Of them, 36 were males and 13 were females, aged 16 to 67 years( 39 years on average). The causes of injuries included mangled injury in 24 cases, high fall injury in 9 cases, cut injury in 7 cases, malignant soft tissue tumor in 5 cases, decubital ulcer in 2 cases, and electric burn in 2 cases. Of the 49 cases, 19 were in left side and 30 in right side. The defect size of skin ranged from 3 cm x 2 cm to 20 cm x 15 cm and deep tissue injuries were accompanied by defects of tendon and ligament in 24 cases, by damage of joint in 12 cases, and by bone defect in 9 cases, and 35 of them had infections, and 2 of them had diabetes of stage 2. The time between the injury and surgery ranged from 4 hours to 1 year. The wounds were repaired separately by local flap (3 cm x 3 cm to 6 cm x 4 cm) in 15 cases, local island flap(8 cm x 5 cm to 12 cm x 7 cm) in 25 cases, free flap (15 cm x 11 cm to 24 cm x 17 cm) in 4 cases, and cross leg flap(5 cm x 4 cm to 8 cm x 6 cm) in 5 cases. In 24 cases of defects of tendon and ligament, 15 underwent the reconstruction in one-stage operations, 9 in two-satge operation. In 9 cases accompanied by bone defect, two-stage bone grafting (12-64 g) was given after wound healed.
All of the 49 flaps survived. Forty-six healed by the first intention and 3 with distal edge necrosis healed after skin grafting. Two patients with sinus formation healed after 6-8 months of dressing change. All the cases were followed up 6 months to 3 years, and all the flaps were well developed, the functions of the foot and ankle were satisfactory.
It can get an excellent result of appearance and function recovery repairing deep wounds of the foot and ankle with proper flaps in earlier time.
总结足踝部深度创面修复方法的临床效果。
2002年3月至2006年6月，对49例足踝部皮肤及深部组织缺损患者进行修复治疗。其中男36例，女13例，年龄16～67岁（平均39岁）。致伤原因包括碾压伤24例，高处坠落伤9例，切割伤7例，恶性软组织肿瘤5例，褥疮2例，电烧伤2例。49例中，左侧19例，右侧30例。皮肤缺损面积为3 cm×2 cm至20 cm×15 cm，深部组织损伤合并肌腱、韧带缺损24例，合并关节损伤12例，合并骨缺损9例，其中35例有感染，2例有2期糖尿病。受伤至手术时间为4小时至1年。创面修复方法：局部皮瓣（3 cm×3 cm至6 cm×4 cm）修复15例，局部岛状皮瓣（8 cm×5 cm至12 cm×7 cm）修复25例，游离皮瓣（15 cm×11 cm至24 cm×17 cm）修复4例，交腿皮瓣（5 cm×4 cm至8 cm×6 cm）修复5例。24例肌腱、韧带缺损患者中，15例一期重建，9例二期重建。9例合并骨缺损患者，创面愈合后二期植骨（12～64 g）。
49例皮瓣全部成活。46例一期愈合，3例皮瓣远端边缘坏死经植皮后愈合。2例形成窦道者经6～8个月换药后愈合。全部病例随访6个月至3年，皮瓣生长良好，足踝部功能满意。
早期选用合适的皮瓣修复足踝部深度创面，可获得外观及功能恢复的良好效果。
