【摘要】：目的：腓腸神經(jīng)營養(yǎng)血管皮瓣修復(fù)兒童踝部組織缺損的可行性和預(yù)后,展望可能的研究方向。 方法：廣泛查閱近年來有關(guān)腓腸神經(jīng)營養(yǎng)血管皮瓣的基礎(chǔ)研究及小腿腓腸神經(jīng)營養(yǎng)血管皮瓣臨床應(yīng)用于修復(fù)足踝部軟組織缺損的文獻(xiàn),選擇常用的小腿腓腸神經(jīng)營養(yǎng)血管皮瓣即腓腸神經(jīng)營養(yǎng)血管筋膜蒂皮瓣修復(fù)兒童足踝部軟組織缺損予以闡述,術(shù)前用多普勒儀探測穿支部位并標(biāo)記。總計采集威海市威海衛(wèi)人民醫(yī)院骨科2006年11月～2013年7月就診的兒童足踝部皮膚軟組織缺損患者共37例。無任何感情傾向及暗示傾向,向患兒家長交代病情后及治療方案后,對其中27例兒童足踝部軟組織缺損采用小腿腓腸神經(jīng)營養(yǎng)血管皮瓣修復(fù)。另取10例病例作為對照組,采用一期VSD負(fù)壓吸引+二期游離植皮術(shù)。 結(jié)果：轉(zhuǎn)移皮瓣組病例術(shù)后皮瓣全部成活,無血管危象及感染發(fā)生,創(chuàng)面均Ⅰ期愈合,平均住院時間17天,均未施行再次手術(shù),除12例伴有骨折的病人,其余患者均自行負(fù)重出院,踝關(guān)節(jié)活動范圍好,術(shù)后隨訪3-6個月皮瓣顏色紅潤血運好,彈性及質(zhì)地良好,皮瓣無色素沉著,外觀好。對照組6例患者創(chuàng)面經(jīng)兩次手術(shù)后愈合,2例病人施行了3次手術(shù),2例病人施行了4次手術(shù),患者出院時均不能完全負(fù)重,踝關(guān)節(jié)活動范圍受限,術(shù)后隨訪3-6個月皮膚均成活,3例因瘢痕組織導(dǎo)致彈性及質(zhì)地差,3例踝關(guān)節(jié)活動范圍仍受限,外觀差。 結(jié)論：小腿腓腸神經(jīng)營養(yǎng)血管皮瓣手術(shù)設(shè)計靈活,對供區(qū)外形及功能影響小,是修復(fù)兒童足踝部軟組織缺損較為理想的方法。提高小腿腓腸神經(jīng)營養(yǎng)血管皮瓣軸心血管的定位,加強(qiáng)基礎(chǔ)研究成果與臨床應(yīng)用的結(jié)合,根據(jù)足踝部不同軟組織缺損的創(chuàng)面情況,選擇合適大小的皮瓣,達(dá)到創(chuàng)面修復(fù)的最佳效果,將是今后的研究方向。
[Abstract]:Objective: to evaluate the feasibility and prognosis of sural neurovascular flap for the repair of ankle tissue defects in children. Methods: the basic research of sural neurovascular flap and the clinical application of sural neurovascular flap in repairing soft tissue defect of foot and ankle were reviewed extensively in recent years. The common sural neurovascular flap (sural nerve nutrient vascular fasciocutaneous flap) was used to repair the soft tissue defect of foot and ankle in children. The perforating branch was detected and labeled by Doppler instrument before operation. A total of 37 cases of foot and ankle skin and soft tissue defects in Department of Orthopaedics of Weihai people's Hospital of Weihai City were collected from November 2006 to July 2013. There was no emotional tendency or hint tendency. After explaining the condition to the parents and after the treatment, 27 cases of soft tissue defects of foot and ankle were repaired by sural neurovascular flap. Another 10 cases as control group were treated with primary VSD negative pressure suction and secondary free skin grafting. Results: in the flap transfer group, all the flap survived, no vascular crisis or infection occurred, the wound healed in the first stage, the average hospitalization time was 17 days, and no reoperation was performed, except for 12 patients with fracture. The rest of the patients were all discharged from hospital with a good range of ankle joint activities. The skin flap was followed up for 3 to 6 months. The skin flap had a good color, good elasticity and texture, no pigmentation and good appearance. In the control group, 6 cases of wound healed after two operations, 2 cases underwent 3 operations, 2 cases underwent 4 times of operation, all the patients were discharged from hospital without full load, and the range of ankle joint movement was limited. The skin survived for 3-6 months after operation, 3 cases had poor elasticity and texture due to scar tissue, and 3 cases had limited range of ankle joint motion and poor appearance. Conclusion: sural neurovascular flap is an ideal method for repairing soft tissue defect of foot and ankle in children because of its flexible design and little influence on the shape and function of donor area. To improve the cardiovascular location of sural neurovascular flap axis of the leg, to strengthen the combination of basic research results and clinical application, and to select the appropriate size flap according to the wound condition of different soft tissue defects in foot and ankle. To achieve the best effect of wound repair will be the research direction in the future.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R726.2

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