Dong Zhonggen, Liu Xi, Liu Lihong, Wei Jianwei, Peng Ping, Peng Xinyu
Department of Orthopaedics, Second Xiangya Hospital, Central South University, Changsha Hunan, 410011, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2016 Nov 8;30(11):1391-1395. doi: 10.7507/1002-1892.20160286.
To introduce a modified technique of a sloped skin island design for the distally based sural nuerofasciocutaneous flap to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, and report the effectiveness of the modified technique.
Between April 2001 and January 2016, 37 patients (38 defects) with longitudinal defects in distal pretibial region or transverse defects in the heel and ankle were treated with the sural nuerofasciocutaneous flap with slope-designed skin island. These patients included 28 males and 9 females, with a median age of 37 years (range, 5-78 years). The horizontal and vertical dimensions ranged from 3 to 8 cm and 8.5 to 14.5 cm in 11 distal pretibial defects, and from 9 to 21 cm and 3.0 to 10.5 cm in 27 heel and ankle defects, respectively. The disease duration ranged from 2 days to 5 years.
When the skin islands were routinely designed, the skin islands of 25 flaps would exceed the lateral limit (the anterior border of the fibula) laterally or medial limit (the medial border of the tibia) medially. After the skin islands were obliquely designed, the horizontal dimensions in 38 flaps decreased an average of 5.4 cm (range, 2.5 to 14.8 cm), and the vertical dimensions increased an average of 5.3 cm (range, 2 to 15 cm). The rotation angles ranged from 42° to 90°, with an average of 67°. Thirty-five flaps survived uneventfully. Margin necrosis occurred in 2 flaps, and partial necrosis in 1 (2.6%) flap. The grafted skins at donor site survived, and primary healing of incision was obtained. All patients were followed up 6 to 42 months (mean, 10 months). No infection or ulceration was noted during the follow-up period, and the appearances of the flaps were satisfactory. At last follow-up, according to Boyden criteria, the limb function was excellent in 30 cases, good in 6 cases, and poor in 2 cases, with the excellent and good rateof 94.7%.
When the distal sural nuerofasciocutaneous flap is used to reconstruct soft tissue defects longitudinal in distal pretibial region or transverse in the heel and ankle, the modified technique of sloped skin island design can decrease the horizontal dimension of the skin island, improve the flap survival rate, and extend its indications.
介绍一种改良的倾斜皮岛设计技术用于远端蒂腓肠神经营养血管皮瓣，以修复胫前远端纵向或足跟及踝部横向的软组织缺损，并报告该改良技术的有效性。
2001年4月至2016年1月，对37例（38处缺损）胫前远端纵向缺损或足跟及踝部横向缺损的患者采用带倾斜设计皮岛的腓肠神经营养血管皮瓣治疗。这些患者包括28例男性和9例女性，中位年龄37岁（范围5 - 78岁）。11例胫前远端缺损的水平和垂直尺寸分别为3至8 cm和8.5至14.5 cm，27例足跟及踝部缺损的水平和垂直尺寸分别为9至21 cm和3.0至10.5 cm。病程为2天至5年。
常规设计皮岛时，25个皮瓣的皮岛会向外侧超出外侧界限（腓骨前缘）或向内侧超出内侧界限（胫骨内侧缘）。采用倾斜设计皮岛后，38个皮瓣的水平尺寸平均减小5.4 cm（范围2.5至14.8 cm），垂直尺寸平均增加5.3 cm（范围2至15 cm）。旋转角度为42°至90°，平均为67°。35个皮瓣顺利存活。2个皮瓣发生边缘坏死，1个皮瓣（2.6%）发生部分坏死。供区植皮存活，切口一期愈合。所有患者随访6至42个月（平均10个月）。随访期间未发现感染或溃疡，皮瓣外观满意。末次随访时，根据Boyden标准，肢体功能优30例，良6例，差2例，优良率为94.7%。
当采用远端蒂腓肠神经营养血管皮瓣修复胫前远端纵向或足跟及踝部横向的软组织缺损时，改良的倾斜皮岛设计技术可减小皮岛的水平尺寸，提高皮瓣成活率，并扩大其适应证。
