Dong Zhong-Gen, Wel Jian-Wei, Liu Li-Hong, Luo Shun-Hong, Yang Yang, Zhou Zheng-Bin, He Miao, Deng Xiangwu
Department of Orthopeadics, 2nd Xiangya Hospital, Central South University, Changsha 410011, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Sep;26(5):331-6.
To explore the influence of proximal-tip location on partial necrosis in distally based sural neuro fasciocutaneous flap.
From April 2001 to May 2009,157 distally based sural neuro fasciocutaneous flaps were conducted to repair the soft tissue defect in distal region of lower leg, ankle and feet in 153 patients. Date of the flaps and the patients were retrospectively analyzed. From the tip of lateral malleolus to the popliteal crease, posterior aspect of the lower leg was equally divided into 9 regions that were 1st to 9th region from inferiorly to superiorly, respectively. The flaps were divided into 2 groups: survival group (including uneventfully survived flaps, flaps with distally epidermal necrosis and with wound dehiscence) and partial necrosis group. Based on the location of the proximal tip of flaps, the flaps were stratified into 4 groups: flaps with the proximal tip locating in the 6th or lower region (group A), the 7th region (group B), the 8th region (group C) and the 9th region (group D). Harvesting the flaps started from exploring the perforator of peroneal vessel in the adipofascial pedicle, then the flaps were elevated retrogradely.
Of the 157 flaps, 125 survived uneventfully,8 showed distal epidermal necrosis,wound dehiscence occurred in 6 flaps, 18 flaps (11.5%) showed distal partial necrosis. Partial necrosis occurred in zero of 19 flaps in group A (0), 1 of 44 flaps in group B (2.3% ), 7 of 62 flaps in group C (11.3% ) and 10 of 32 flaps in group D (31.3% ). The differences in partial necrosis rate between group A and group B , group B and group C, were not statistically significant (P > 0.05). Partial necrosis rate was higher in group D than in group C (P = 0.012), it was lower in group A + group B (1.6%) than in group C + group D (18. 1% ) (P = 0. 001).
Distally based sural neuro fasciocutaneous flap can survive reliably when the proximal tip of flap is not beyond the junction between lower 7/9 and upper 2/9 of the lower leg, whereas probability of partial necrosis occurring in the flap increase significantly when the proximal tip of flap locates in upper 1/9 of the lower leg.
探讨腓肠神经营养血管筋膜皮瓣近端蒂位置对皮瓣远端部分坏死的影响。
回顾性分析2001年4月至2009年5月期间，153例应用157例腓肠神经营养血管筋膜皮瓣修复小腿远端、踝部及足部软组织缺损患者的皮瓣及患者资料。将小腿后侧自外踝尖至腘横纹平均分为9个区域，从下至上依次为第1至第9区。将皮瓣分为2组：成活组（包括皮瓣顺利成活、远端表皮坏死及伤口裂开但愈合的皮瓣）和部分坏死组。根据皮瓣近端蒂的位置，将皮瓣分为4组：近端蒂位于第6区及以下区域的皮瓣为A组，位于第7区的为B组，位于第8区的为C组，位于第9区的为D组。切取皮瓣时先在脂肪筋膜蒂内寻找腓血管穿支，然后逆行掀起皮瓣。
157例皮瓣中，125例顺利成活，8例出现远端表皮坏死，6例出现伤口裂开，18例（11.5%）出现远端部分坏死。A组19例皮瓣中部分坏死0例（0），B组44例皮瓣中1例（2.3%），C组62例皮瓣中7例（11.3%），D组32例皮瓣中10例（31.3%）。A组与B组、B组与C组部分坏死率差异无统计学意义（P＞0.05）。D组部分坏死率高于C组（P = 0.012），A组+B组（1.6%）低于C组+D组（18.1%）（P = 0.001）。
腓肠神经营养血管筋膜皮瓣近端蒂不超过小腿下7/9与上2/9交界处时皮瓣可可靠成活，而当皮瓣近端蒂位于小腿上1/9时皮瓣出现部分坏死的概率显著增加。
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