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目的探讨采用组合式外固定架并腿固定联合健侧隐神经营养血管皮瓣桥式移位修复小腿及足踝部创面的疗效。方法 2009年8月-2013年8月,收治小腿及足踝部创面29例。男18例,女11例;年龄11~65岁,平均37.6岁。伤后至该次手术时间为14~36 d,平均22.3 d。创面部位:足底及足跟部5例,足背部2例,踝部4例,小腿中下段14例,小腿上段4例。创面范围为5 cm×3 cm~19 cm×9 cm。采用组合式外固定架并腿固定,带蒂逆行或顺行隐神经营养血管皮瓣桥式移位修复创面,皮瓣切取范围6 cm×4 cm~22 cm×11 cm;供区直接拉拢缝合或植皮修复。术后3~4周行皮瓣断蒂术并拆除并腿固定。结果术后皮瓣均成活,创面Ⅰ期愈合;供区切口均Ⅰ期愈合,植皮成活。患者均获随访,随访时间6~18个月,平均13.2个月。皮瓣外观良好,足底感觉恢复良好,行走后无破溃。结论与交腿固定相比,组合式外固定架并腿固定方法简便,固定牢靠,患者体位舒适,可允许关节活动;隐神经营养血管皮瓣切取不牺牲小腿主干血管,能重建感觉,是修复小腿及足踝部创面有效方法之一。
Objective To investigate the curative effect of combined external fixator combined with leg fixation and bridge of lateral pedicel of saphenous nerve nutrient vessel flap in the repair of lower leg and ankle. Methods From August 2009 to August 2013, 29 cases of lower calf, ankle and foot wounds were treated. There were 18 males and 11 females, aged from 11 to 65 years (mean 37.6 years). After the injury to the time of surgery was 14 ~ 36 d, an average of 22.3 d. Wound site: foot and heel in 5 cases, 2 cases of dorsal foot, ankle in 4 cases, 14 cases of lower leg in the lower leg in 4 cases. The wound area ranged from 5 cm × 3 cm to 19 cm × 9 cm. A total of 6 cm × 4 cm ~ 22 cm × 11 cm was excised by combined external fixator with leg fixation, pedicled retrograde or anterolateral saphenous neurovascular flap to repair the wound. The donor area was directly sutured and sutured Or skin graft repair. 3 to 4 weeks after surgery pedicle flap pedicle and removal and leg fixation. Results All the flaps survived and the wound was healed in the first stage. All the wounds were healed by first intention and the skin graft survived. All patients were followed up for 6-18 months with an average of 13.2 months. Flap appearance good, plantar feel good recovery, no rupture after walking. Conclusions Compared with orthodontic fixation, combined external fixator and leg fixation is simple and reliable, and the patient’s position is comfortable, allowing joint activity. The saphenous neurovascular flap can be rehabilitated without sacrificing the trunk of the leg. Calf and ankle wounds one of the effective ways.