目的 评价不同皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损的效果，探讨小腿及足踝部皮肤软组织缺损的理想修复方法。 方法 2002年6月－2010年1月，应用15种皮瓣、肌皮瓣修复128例（138处）小腿及足踝部皮肤软组织缺损。其中小腿中上段21处，小腿中下段45处，内外踝及足跟部43处，足背及前足29处。主要应用最多的皮瓣有腓肠神经营养血管皮瓣、腓肠肌内外侧头肌皮瓣、腓浅神经营养血管皮瓣和足底内侧皮瓣。修复软组织缺损范围5 cm×4 cm～23 cm×14 cm。 结果 术后135处创面Ⅰ期愈合，皮瓣完全成活；2处皮瓣部分坏死，经二次手术植皮修复；1例游离股前外侧皮瓣修复小腿中下段软组织缺损，皮瓣完全坏死，后改取对侧腓肠神经营养血管交腿皮瓣修复成活。腓肠神经营养血管皮瓣应用例数最多，成活率高，吻合血管的游离皮瓣坏死率较高。术后患者均获随访1～10年，平均23个月，皮瓣均成活良好, 无溃疡、渗液等。 结论 正确认识并选择皮瓣、肌皮瓣修复小腿及足踝部皮肤软组织缺损可提高皮瓣成活率，恢复肢体良好功能，腓肠神经营养血管皮瓣是一种修复小腿及足踝部软组织缺损的理想皮瓣。
【摘要】 目的 探讨大面积手部皮肤脱套伤并缺损的修复方式。 方法 2005年6月－2010年1月，应用腹部皮瓣包埋和游离中厚皮片植皮结合负压封闭引流（vacuum sealing drainage，VSD）技术治疗手部大面积皮肤脱套伤合并缺损12例，其中男8例，女4例；年龄21~56岁，平均34岁。机器绞伤9例，车祸伤3例。所有损伤均合并肌腱、关节或骨质外露；软组织缺损范围为9 cm×8 cm~25 cm×18 cm。受伤至手术时间4~17 h，平均6.5 h。手掌及手指缺损部位采用腹部带蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游离中厚皮片植皮，再于植皮表面覆盖VSD敷料，接负压行持续吸引；所有患者均二期断蒂并进行分指或皮瓣成形手术。 结果 术后2例手指部分皮瓣或植皮坏死，2例小部分皮瓣及植皮边缘坏死，经单纯换药后逐渐愈合，1例缺损较大、较深，先行换药，待创面肉芽新鲜后行二期植皮手术，愈合良好 。其余皮瓣及植皮均成活，创面Ⅰ期愈合；供区植皮均成活，切口均Ⅰ期愈合。12例均获6~42个月随访，2例手指末节软组织缺损严重、血运差，术后7~10 d末节坏死后短缩；3例掌侧皮瓣移植后较臃肿；其余外观均较满意。所有患者创面愈合后1个月内深、浅感觉功能均稍差，3~6个月逐渐恢复，但手指精细感觉恢复差，两点辨别觉为6~13 mm，平均9.5 mm。所有患手平均掌指关节主动活动50°，指间关节20°。 结论 腹部皮瓣包埋和游离中厚皮片植皮结合VSD技术能较好地修复手部大面积皮肤脱套伤并缺损，是一种实用、安全且简便的手术方法。【Abstract】 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.