腓肠神经营养血管皮瓣逆行修复儿童跟腱部轮辐伤

摘要

目的 探讨儿童跟腱部轮辐伤的临床特点及腓肠神经营养血管皮瓣的运用.方法 我院2007年3月~2010年6月收治因摩托车轮致跟腱部轮辐伤患儿15例,软组织缺损范围2cm×2cm~7cm×5.5cm,根据朱跃良标准分型:Ⅰ型1例,Ⅱ12例,Ⅲ型2例.跟腱及骨骺早期清创后带线锚钉或可吸收线修复,跟腱缺损者选择跟腱翻转筋膜条重建,并采用腓肠神经营养血管皮瓣修复创面,皮瓣切取范围4.5cm×4.0cm~10.5cm×7.5cm,供区中厚皮片游离植皮治疗.结果 术后14例皮瓣存活.1例出现皮瓣远端部分坏死,经换药植皮后治愈;2例术后早期创缘渗出,经换药后愈合;后期1例出现供区上缘麻胀感.15例获随访12~15个月,平均13个月.皮瓣质地柔软,外观良好,踝关节功能恢复良好.1例皮瓣臃肿,经Ⅱ期修整削薄后外观改善.结论 摩托车轮致儿童跟腱部轮辐伤大多污染严重,同时存在跟腱、跟骨骨骺损伤及足跟部皮肤缺损,尽可能早期手术修复,可达到良好的临床效果.%Objective To investigate the clinical features of the Achilles tendon spoke injury for children and the use of sural neurocutaneous vascular flap.Methods Fifteen children with Achilles tendon spoke injury from Mar.2007 to Jun.2010 were retrospectively analyzed.According to Zhu Yueliang typing criteria ,there was 1 case of Type I ,12 cases of Type II ,2 cases of Type Iii.After early debridement ,all patients were treated by anchors or absorbable suture repair in the Achilles tendon and epiphysis.Patients with Achilles tendon defect were treated with Achilles tendon flip fascia reconstruction ,and used sural neurocutaneous vascular flap to repair the wound.The flap ranged from 4.5cm×4.0cm to 10.5cm ×7.5cm.The donor site was treated by thick skin graft.Results Fourteen cases treated by sural neurocutaneous vascular flap were recovered very well ,only one case got necrosis at distal end and recovered after dermatoplasty.At early stage,two cases got boundary exudation and re — covered by changing dressings.At advanced stage ,one case got numbness and expansion at upper border of donor area.Fifteen cases were followed up for 12 to 15 months and 13 months on average.Flaps were soft and good-looking.Ankle joints were obtained good functional recovery.Only one case'flap showed fat and clumsy,which was improved after shaving operation at II stage.Conclusion Achilles tendon spoke injury by motorcycle wheels among children is always contaminated severely ,which is often combined with injury around calcaneus epiphyses or Achilles tendon.It can achieve good clinical results after surgical repair as early as possible.