腓肠神经营养血管皮瓣修复前足及踝周软组织缺损的疗效比较。
Outcome comparison of sural neurofasciocutaneous flap for reconstructing soft tissue defects in forefoot and around ankle.
机构信息
Department of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha 410011.
Department of Orthopedics, Second Xiangya Hospital, Central South University, Changsha 410011, China.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2022 Jan 28;47(1):79-85. doi: 10.11817/j.issn.1672-7347.2022.211227.
OBJECTIVES
To summarize our experience with the sural neurofasciocutaneous flap for reconstructing the soft tissue defects over the forefoot distal to the connecting line of midpoints in the metatarsal bones, and to compare the outcomes between the flap for resurfacing the defects distal and proximal to the connecting line.
METHODS
The clinical data of 425 sural neurofasciocutaneous flaps for repairing the soft tissue defects in the middle and lower leg, ankle, and foot between Apr. 2002 and Apr. 2020 were reviewed. Based on the connecting line of midpoints of the metatarsals, the sural neurofasciocutaneous flaps were divided into a forefoot group (flaps with furthest edges distal to the connecting line) and a peri-ankle group (flaps with the furthest edges proximal to the connecting line).
RESULTS
The partial necrosis rate in the forefoot group (14.5%, 10/69) was significantly higher than that in the peri-ankle group (7.0%, 25/356), with significant difference (<0.05). Using the flap alone or in combination with a simple salvage treatment, the ratio of successful coverages of the defects was 98.6% (68/69) in the forefoot group, and 97.8% (348/356) in the peri-ankle group, respectively, with no statistical difference (>0.05).
CONCLUSIONS
The sural neurofasciocutaneous flap is a better choice for covering the soft tissue defects over the forefoot distal to the connecting line of midpoints of the metatarsal bones. The survival reliability of the sural neurofasciocutaneous flap reconstructing the soft tissue defect proximal to the connecting line is superior to that of the flap reconstructing the defect distal to the connecting line.
目的
总结应用腓肠神经营养血管皮瓣修复跖骨中跗点连线远侧前足软组织缺损的经验，并比较皮瓣修复跖骨中跗点连线远侧和近侧缺损的效果。
方法
回顾 2002 年 4 月至 2020 年 4 月间应用腓肠神经营养血管皮瓣修复小腿、踝和足部中、下段及足部软组织缺损的临床资料。根据跖骨中跗点连线，将腓肠神经营养血管皮瓣分为前足组（皮瓣最远端位于连线远侧）和踝周组（皮瓣最远端位于连线近侧）。
结果
前足组（14.5%，10/69）的部分坏死率明显高于踝周组（7.0%，25/356），差异有统计学意义（<0.05）。单纯应用皮瓣或联合简单挽救治疗，前足组缺损覆盖成功率为 98.6%（68/69），踝周组为 97.8%（348/356），差异无统计学意义（>0.05）。
结论
腓肠神经营养血管皮瓣是修复跖骨中跗点连线远侧前足软组织缺损的较好选择。腓肠神经营养血管皮瓣修复跖骨中跗点连线近侧软组织缺损的生存可靠性优于修复远侧缺损。
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