神经血管蒂皮瓣联合抗生素硫酸钙治疗踝周感染创面△（开放获取）

(Open Access) Neurovascular pedicle flap combined with antibiotic calcium sulfate in treatment of infectious wounds around the ankle

摘要:

[目的] 介绍神经血管蒂皮瓣联合抗生素硫酸钙治疗踝周感染创面的手术技术和初步临床结果。[方法] 2016 年4月—2022 年6 月对21 例踝周感染创面采用神经血管蒂皮瓣联合抗生素硫酸钙治疗。术前高频彩色超声标记创面周围隐神经及胫后动脉穿支。清创后切开皮瓣一侧皮缘，在轴线及旋转点附近找到隐神经及胫后动脉穿支，保留轴线两侧1.5~2.0 cm 宽筋膜组织。将皮瓣通过开放隧道转位覆盖创面。将制备好的抗生素硫酸钙颗粒填塞于皮瓣深层空腔内。在显微镜下将皮瓣携带的隐神经与供区可吻合皮神经行端-端吻合。供瓣区创面直接闭合或取大腿中厚皮片植皮修复。[结果] 21 块皮瓣及供瓣区植皮全部成活，供瓣区切口均一期愈合。随访时间（15.2±4.9） 个月。皮瓣外形良好，耐磨、质地柔软。所有患者均无感染复发并恢复正常生活。末次随访足踝关节功能评定：优10 例，良10 例，可1 例，优良率95.2%。[结论] 神经血管蒂皮瓣联合抗生素硫酸钙治疗踝周感染创面，操作简单，效果良好。

关键词:隐神经营养血管皮瓣;穿支皮瓣;硫酸钙;感染;创面修复

Abstract:

[Objective] To introduce the surgical technique and preliminary clinical results of neurovascular pedicle flap combinedwith antibiotic calcium sulfate in treatment of infectious wounds around the ankle. [Methods] From April 2016 to June 2022, a total of 21patients with infectious wounds around the ankle were treated by neurovascular pedicle flap combined with antibiotic calcium sulfate. Thesaphenous nerve and posterior tibial artery perforators around the wound was marked by high-frequency color doppler ultrasound preopera-tively. After debridement, the skin margin on one side of the flap was firstly cut to expose the saphenous nerve and posterior tibial arteryperforators near the flap axis and rotation point. After that, the flap was freed with subcutaneous fascia tissue about 1.5~2.0 cm in wide onboth sides of the flap axis retained. The flap was transferred to cover the wound by an open tunnel. The prepared antibiotic calcium sulfateparticles were filled into the cavity below the flap. Subsequently, the saphenous nerve was anastomosed end-to-end with the nerve stumpsat donor site under microscope. The flap donor site was sutured directly or repaired by intermediate split thickness skin graft harvested fromthe thigh. [Results] All 21 patients had flaps and skin grafts at donor site survived uneventfully with the incisions at the donor site healed inexcellent grade, and were followed up for (15.2±4.9) months in a mean. All patients returned to normal life without infection recurrence, hadappearance of the flaps looked good with a wear-resistant and soft texture. At the latest follow-up, the function of the affected ankle andfoot was marked as excellent in 10, good in 10, and fair in 1, with excellent and good rate of 95.2%. [Conclusion] This neurovascular pedi-cle flap combined with antibiotic calcium sulfate is a good option for treating infectious wounds at the distal leg and the ankle and foot withadvantages of simple procedure and good outcome.

Key words:saphenous neurovascular flaps; perforator flap; calcium sulfate; infection; wound repair