| 郑润泉,邹林,张贵春,等.邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效.骨科,2017,8(1): 12-15. |
| 邻近逆行穿支带蒂双皮瓣修复足部贯通伤的临床疗效 |
| Clinical effectiveness of double adjacent perforator flaps with pedicle for repairing penetrating wound of feet |
| 投稿时间：2016-06-03 |
| DOI：10.3969/j.issn.1674-8573.2017.01.004 |
| 中文关键词: 足 创伤，贯通性 软组织损伤 外科皮瓣 修复 |
| 英文关键词: Foot Wounds, penetrating Soft tissue injuries Surgical flaps Repair |
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| 中文摘要: |
| 目的 探讨邻近逆行穿支带蒂双皮瓣修复足部贯通伤的治疗经验及临床疗效。方法 2010年1月至2014年7月，我科收治9例足部贯通伤病人，伤足均有不同程度的两侧软组织缺损，早期彻底清创、止血，大量液体冲洗下负压封闭引流覆盖创面，择期以邻近逆行带蒂腓肠神经营养血管皮瓣和内踝上皮瓣一次性修复两侧皮肤软组织缺损。术后观察皮瓣存活情况，并采用美国足踝外科医师协会（AOFAS）踝与后足功能评分系统评价伤足的恢复情况。结果 术后2例皮瓣边缘坏死，分别经换药和植皮后成活；1例外侧皮瓣创口长时间渗液，经换药引流，4周后愈合；其余病人皮瓣均顺利成活，供区创面一期愈合。本组9例均获随访，病人对其外形、色泽、厚度可接受。AOFAS踝与后足功能评分系统评价均为优。结论 邻近逆行穿支带蒂双皮瓣是修复足部贯通伤的有效方法，围手术期处理使污染创面变成相对清洁创面是皮瓣成功的基础条件，合理选择、设计皮瓣，深筋膜充分填塞创腔是治疗成功的关键。 |
| 英文摘要: |
| Objective To explore the treatment methods and clinical effectiveness of double adjacent perforator flaps with pedicle for repairing penetrating wound of feet. Methods Between January 2010 and July 2014, 9 patients with penetrating wound of feet were surgically treated in our hospital. The feet had different degrees of bilateral skin and soft tissue defects. After debridement, hemostasis, flushing, and drainage with VSD technology, penetrating wound of feet was repaired with sural neurouascular and medial supramalleolar perforator flaps with pedicle in a one-stage procedure. The flap survival conditions were observed after operation, and the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used to evaluate the recovery of the affected feet. Results Two cases had partial skin necrosis at the distal site: one case healed after dressing, and the other healed after applying additional dermoplasty. In another case, flap blood supply was good, but the wound was continuous discharging, which was healed through dressing and drainage over 4 weeks. The rest of the flaps survived, as well donor wounds primarily healed. All cases were followed up, and the satisfaction rate of patients was 100% in its shape, color and thickness. Conclusion Double adjacent perforator flaps with pedicle for repairing penetrating wound of feet could achieve better outcomes, and had preferable value in clinical application. Perioperative treatment that making the contaminated wound into relatively clean wound was the basis of the flap survived, and reasonable design of skin flap, and fully filling of cavity in the deep fascia were the key to the success of the treatment. |
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