目的 評價(jià)不同皮瓣、肌皮瓣修復(fù)小腿及足踝部皮膚軟組織缺損的效果，探討小腿及足踝部皮膚軟組織缺損的理想修復(fù)方法。 方法 2002年6月－2010年1月，應(yīng)用15種皮瓣、肌皮瓣修復(fù)128例（138處）小腿及足踝部皮膚軟組織缺損。其中小腿中上段21處，小腿中下段45處，內(nèi)外踝及足跟部43處，足背及前足29處。主要應(yīng)用最多的皮瓣有腓腸神經(jīng)營養(yǎng)血管皮瓣、腓腸肌內(nèi)外側(cè)頭肌皮瓣、腓淺神經(jīng)營養(yǎng)血管皮瓣和足底內(nèi)側(cè)皮瓣。修復(fù)軟組織缺損范圍5 cm×4 cm～23 cm×14 cm。 結(jié)果 術(shù)后135處創(chuàng)面Ⅰ期愈合，皮瓣完全成活；2處皮瓣部分壞死，經(jīng)二次手術(shù)植皮修復(fù)；1例游離股前外側(cè)皮瓣修復(fù)小腿中下段軟組織缺損，皮瓣完全壞死，后改取對側(cè)腓腸神經(jīng)營養(yǎng)血管交腿皮瓣修復(fù)成活。腓腸神經(jīng)營養(yǎng)血管皮瓣應(yīng)用例數(shù)最多，成活率高，吻合血管的游離皮瓣壞死率較高。術(shù)后患者均獲隨訪1～10年，平均23個(gè)月，皮瓣均成活良好, 無潰瘍、滲液等。 結(jié)論 正確認(rèn)識并選擇皮瓣、肌皮瓣修復(fù)小腿及足踝部皮膚軟組織缺損可提高皮瓣成活率，恢復(fù)肢體良好功能，腓腸神經(jīng)營養(yǎng)血管皮瓣是一種修復(fù)小腿及足踝部軟組織缺損的理想皮瓣。
【摘要】 目的 探討大面積手部皮膚脫套傷并缺損的修復(fù)方式?！》椒ā?005年6月－2010年1月，應(yīng)用腹部皮瓣包埋和游離中厚皮片植皮結(jié)合負(fù)壓封閉引流（vacuum sealing drainage，VSD）技術(shù)治療手部大面積皮膚脫套傷合并缺損12例，其中男8例，女4例；年齡21~56歲，平均34歲。機(jī)器絞傷9例，車禍傷3例。所有損傷均合并肌腱、關(guān)節(jié)或骨質(zhì)外露；軟組織缺損范圍為9 cm×8 cm~25 cm×18 cm。受傷至手術(shù)時(shí)間4~17 h，平均6.5 h。手掌及手指缺損部位采用腹部帶蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游離中厚皮片植皮，再于植皮表面覆蓋VSD敷料，接負(fù)壓行持續(xù)吸引；所有患者均二期斷蒂并進(jìn)行分指或皮瓣成形手術(shù)。 結(jié)果 術(shù)后2例手指部分皮瓣或植皮壞死，2例小部分皮瓣及植皮邊緣壞死，經(jīng)單純換藥后逐漸愈合，1例缺損較大、較深，先行換藥，待創(chuàng)面肉芽新鮮后行二期植皮手術(shù)，愈合良好 。其余皮瓣及植皮均成活，創(chuàng)面Ⅰ期愈合；供區(qū)植皮均成活，切口均Ⅰ期愈合。12例均獲6~42個(gè)月隨訪，2例手指末節(jié)軟組織缺損嚴(yán)重、血運(yùn)差，術(shù)后7~10 d末節(jié)壞死后短縮；3例掌側(cè)皮瓣移植后較臃腫；其余外觀均較滿意。所有患者創(chuàng)面愈合后1個(gè)月內(nèi)深、淺感覺功能均稍差，3~6個(gè)月逐漸恢復(fù)，但手指精細(xì)感覺恢復(fù)差，兩點(diǎn)辨別覺為6~13 mm，平均9.5 mm。所有患手平均掌指關(guān)節(jié)主動活動50°，指間關(guān)節(jié)20°。 結(jié)論 腹部皮瓣包埋和游離中厚皮片植皮結(jié)合VSD技術(shù)能較好地修復(fù)手部大面積皮膚脫套傷并缺損，是一種實(shí)用、安全且簡便的手術(shù)方法?！続bstract】 Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects. Methods From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out. Results All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°. Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.