Retrograde sural neurovascular flap transplantation for chronic calcaneal osteomyelitis

doi:10.3969/j.issn.2095-4344.2013.53.001

Abstract

Abstract:

BACKGROUND: Calcaneal osteomyelitis treatment is necessary that not only eliminates foci of osteomyelitis, seals the wound, repairs soft tissue defects, but also restores normal body shape and protects weight-bearing foot function as much as possible. Sural neurovascular flaps cannot damage major blood vessels of the lower limbs and appears to have the large arc of rotation, constant and reliable blood supply, which are suitable for repair of chronic calcaneal osteomyelitis.
OBJECTIVE: To study the operating method and clinical results of repairing chronic calcaneal osteomyelitis using retrograde sural neurovascular island flaps.
METHODS: Totally 28 patients with chronic calcaneal osteomyeliti were treated with the distally-based sural musculocutaneous flap in the Department of Orthopedics, People’s Hospital of Ganzhou, from May 2008 to June 2012. The donor defects were closed primarily in 23 patients and were resurfaced with the split-thickness skin graft in five patients.
RESULTS AND CONCLUSION: All the musculocutaneous flaps survived completely in 28 cases, four of which got some distal necrosis of the skin flap, and cured by dressing. All the flaps had good shapes and well-function, and exhibited no recurrence of osteomyelitis. All patients were able to walk normally. These findings indicate that the retrograde sural neurovascular flap transplantation is effective and feasible for treatment of chronic calcaneal osteomyelitis.

中国组织工程研究杂志出版内容重点：肾移植；肝移植；移植；心脏移植；组织移植；皮肤移植；皮瓣移植；血管移植；器官移植；组织工程

全文链接：

Key words: osteomyelitis, calcaneus, surgical flaps, sural nerve

CLC Number:

R318

Cai Xing-jian, Zhou Jian-guo, Qian Rui, Xiao Shi-liang. Retrograde sural neurovascular flap transplantation for chronic calcaneal osteomyelitis[J]. Chinese Journal of Tissue Engineering Research, 2013, 17(53): 9101-9106.

Figures/Tables 3

2.1 参与者数量分析所有患者均进入结果分析，无脱失。最终纳入28例患者，其中男15例，女13例，年龄10-72岁，平均32岁；其中有12例患者采用抗炎换药或中医中药等保守治疗6个月以上未愈合，合并糖尿病5例，合并高血压4例。病程为2-13个月，平均8个月。 2.2 逆行腓肠神经营养血管肌皮瓣移植治疗慢性跟骨骨髓炎的愈合情况及不良反应 28例患者皮瓣移植后逆行移位肌皮瓣全部成活，其中4例出现肌皮瓣远端皮缘部分坏死，均经换药后愈合；供区创面均Ⅰ期愈合。28例均获随访，随访时间3-46个月，平均24个月，肌皮瓣无臃肿，质地优，外形满意，功能感觉良好，跟骨骨髓炎未见复发，无并发症发生，所有患者均恢复正常行走。 2.3 逆行腓肠神经营养血管肌皮瓣移植治疗慢性跟骨骨髓炎的并发症及不良反应所有皮瓣移植患者未出现明显的并发症及不良反应。 2.4 典型病例患者，男，42岁，因左跟骨骨折后感染并皮肤缺损后9个月转入赣州市人民医院骨科治疗。入院诊断为左跟骨闭合骨折后；左跟骨慢性骨髓炎；左足跟部皮肤缺损并感染。检查：左跟部可见长5.5 cm×3.0 cm皮肤缺损，深达跟骨，跟骨钢板外露，有少量脓性分泌物。皮瓣移植中给予取出跟骨钢板，切除创缘炎性组织及瘢痕组织，将坏死及炎性跟骨部分予以切除，彻底清创后创面为5.5 cm×3.0 cm×2.0 cm，切取腓肠神经营养血管肌皮瓣7.0 cm×4.5 cm，其中肌瓣2.5 cm×2.0 cm，旋转点位于外踝尖上5.0 cm，蒂宽约3.0 cm，从明道移位修复跟部创面，供区直接缝合。术后皮瓣成活，创面愈合良好。移植后随访18个月跟骨骨髓炎未见复发，患者恢复正常行走，患者治疗过程及随访情况见图1-7。"

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