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COMPARISON BETWEEN TWO DIFFERENT REPAIRING METHODS FOR SKIN DEFECTS OF FOOT AND ANKLE

Objective To explore a suitable repairing method for skin defects of the foot and ankle, and to evaluate the therapeutic effects of the different repairing methods. Methods From January 2000 to October 2005, 36 patients with skin defects of the foot and ankle underwentthe repairing treatment, of whom 35 were males and 1 was female, aged 5-62 years, averaged 38 years. Of the 36 patients, 12 had an injury by a machine, 22 had a traffic accident, 1 had an infection, and 1 had a cold injury. And the injuries involved the dorsum of the foot, heel, forefoot, and medial or lateral malleolus. The injuries were respectively treated by 2 different repairing methods, the repair with the coverage by the lateral supramalleolar flaps and the repair with the coverage by the reverse sural neurocutaneous flaps. The skin defectsranged in area from 5 cm×4 cm to 20 cm×10 cm. The lateral supramalleolar flapwas used in 15 patients (15 flaps) with a flap area of 5 cm×4 cm-15 cm×8 cm,and the reverse sural neurocutaneous flap was used in 21 patients (22 flaps) with a flap area of 6 cm×4 cm20 cm×10 cm. We retrospectively observed the therapeutic results and compared the success rates of the two methods. Results Of the 36 patients, 15 underwent the repair with the coverage by 15 lateral supramalleolar flaps; 10 achieved a complete survival of the flaps, 2 developed an epidermal necrosis over the distal part, and 3 developed a complete necrosis.The other 21 patients underwent the repair with the coverage by 22 reverse sural neurocutaneous flaps. Of the 22 flaps, 21 had a complete survival, and only 1 failed to survive. The comparison revealed that there was no difference in the color, texture, and contour of the flaps between the 2 repaired groups. And the patients in the 2 groups were equally satisfied with the repairing treatments. The sensation of the flaps recovered to S0-S1. Conclusion The repairing of the foot and ankle skin defects with the coverage by the lateral supramalleolar flaps or by the reverse sural neurocutaneous flaps can achieve a similar good therapeutic result. However, the repair with the lateral supramalleolarflaps is more suitable for the skin defect of a smaller area over the medial orlateral malleolus, or the proximal dorsum of the foot; the repair with the reverse sural neurocutaneous flaps is more suitable for the skin defect of a larger area over the foot and ankle without serious destruction of the malleolar arterial rete.

腓肠神经营养血管皮瓣修复小腿及足踝部软组织缺损

目的 总结腓肠神经营养血管逆行皮瓣修复小腿中下部及足踝部软组织缺损的临床效果。 方法 2001 年1 月－ 2006 年12 月，采用腓肠神经营养血管逆行皮瓣修复小腿中下部及足踝部软组织缺损12 例。男7 例，女5 例；年龄23 ～ 56 岁。车祸伤5 例，重物压伤3 例，皮带绞伤2 例，慢性溃疡2 例。缺损部位：小腿中下部8 例，足跟部2 例，内、外踝各1 例。软组织缺损范围为5 cm × 3 cm ～ 11 cm × 8 cm。均伴骨、关节、肌腱或钢板外露。急诊手术1 例，择期手术11 例。 结果 术后2 例皮瓣边缘坏死，经对症处理后成活；余皮瓣均顺利成活。供区伤口Ⅰ期愈合，植皮顺利成活。12 例均获随访，随访时间9 个月～ 2 年。皮瓣质地良好，厚薄均匀，色泽与周边皮肤相似，下肢负重、行走正常。 结论 腓肠神经营养血管逆行皮瓣质地良好，厚薄均匀，是修复小腿中下部及足踝部软组织缺损的理想皮瓣。

小隐静脉腓肠神经营养皮瓣在足踝创面的临床应用

Reconstruction of the donor area of distally based sural flap with relaying lateral gastrocnemius artery perforator propeller flap

Objective To investigate the clinical application of relaying lateral gastrocnemius artery perforator flap in reconstruction of the donor defect after distally sural flap transferring. Methods Between January 2014 and January 2016, 12 cases with foot and ankle defects were treated. There were 10 males and 2 females with an average age of 23.4 years (mean, 14-52 years). The injury was caused by motorcycle accident in 7 cases and traffic accident in 5 cases. The injury located at left limb in 7 cases and right limb in 5 cases. The size of soft tissue ranged from 10 cm×4 cm to 12 cm×6 cm. The disease duration was 2-84 hours (mean, 26.2 hours). The foot and ankle defects were reconstructed by distally sural flaps, then the flap donor sites were reconstructed with relaying lateral gastrocnemius artery perforator flap at the same stage. The size of distally sural flap ranged from 11 cm×5 cm to 13 cm×7 cm. The size of relaying flap ranged from 7 cm×4 cm to 10 cm×6 cm. Results All flaps survived uneventfully. All recipient sites and donor sites healed smoothly. No vascular crisis, wound dehiscence, or evident swelling occurred. All patients were followed up 6-14 months (mean, 12.4 months) with satisfied esthetic and functional results in recipient and donor sites. There were only linear scar on the donor sites. The color and contour was satisfying, the function of calf and foot were not affected. Conclusion The relaying lateral gastrocnemius artery perforator flap combined with distally sural flap is an idea choice to reconstruct foot and ankle defect, which can avoid donor site skin grafting, minimize donor site morbidity.

超长腓肠神经营养血管蒂逆行岛状皮瓣移位修复足底软组织皮肤缺损

目的 总结超长腓肠神经营养血管皮瓣的血供特点及修复足底皮肤软组织缺损的临床效果。 方法 2003年1月～2005年 11月，临床应用3例，根据缺损部位大小、距离，保留外踝上7.5～8.5 cm处直径较粗大的腓动脉肌间隔皮支（或胫后动脉肌皮支），并以此处作为皮瓣旋转点，在国窝处设计超长的筋膜蒂皮瓣，功能皮瓣大小范围9.0 cm×8.5 cm～15.0 cm×9.0 cm，等腰三角形皮瓣大小为16.5 cm×4.5 cm。逆行移位修复足底处皮肤缺损，3例皮瓣筋膜蒂长度均在16 cm以上。 结果 术后3例皮瓣均成活,创面修复效果好，随访1～6个月，伤肢外形及功能恢复满意，皮瓣感觉基本恢复，足底负重行走及耐磨功能正常。两点辨别觉6～9 mm。 结论 保留位于外踝上7.5～8.5 cm处较粗大的筋膜蒂穿支血管，切取位于窝处的逆行筋膜皮瓣，血供可靠，可修复较长距离的足底、足背皮肤软组织缺损。