跟骨骨髓炎与足跟皮肤缺损的治疗(临床研究)

作者：陈传功钱君红

单位：解放军292医院外二科，北京100026

关键词：骨髓炎；跟；软组织损伤；外科皮瓣

NewPage1

【摘要】目的探讨跟骨骨髓炎及足跟皮肤大块缺损的治疗方法。方法采用拇展肌、小趾展肌肌瓣转移充填死腔，改善局部血运。采用腓动脉逆行皮瓣，拇展肌岛状皮瓣转移治疗足跟皮肤大块缺损9例。结果随访1年～16年3个月，平均81个月，骨髓炎无复发，足跟肌皮瓣有感觉，耐磨擦。结论拇展肌、小趾展肌有知名血管为蒂、血运丰富、抗感染力强，是治疗跟骨骨髓炎理想的充填材料。拇展肌岛状皮瓣修复足跟皮肤缺损面积大,皮肤血运、感觉好，负重行走不发生溃疡。腓动脉逆行皮瓣修复足跟皮肤缺损耐磨性差易破溃，有一个较长时期的皮肤角化过程，需适当保护。

【中图分类号】R681.2

Treatmentofcalcaneusosteomyelitisandskindefect

ChenChuangong，QianJunhong

（No2DepartmentofSurgery,No292PLAHospital,Beijing100026）

【Abstract】ObjectiveTostudytreatingmethodofthecalcaneusosteomylitisandskindefectoftheposteriorheel.Methods9casesofcalcaneusosteomylitisandskindefectweretreatedwithabducthallucisabductordigitisminimitransfertofillindeadspace,abductorhallucismusclewithskinflapgrafttoreconstituteheeldefect,andperonealarteryislandflap.ResultsThrough1～16years3monthsfollowup,average81months,itisfoundthatcalcaneusosteomylitiswererecovered.ConclusionCalcaneusosteomylitiscanbecuredbytheabductorhallucisandabductordigitiminimitransfer,whichcanprovideadequatebloodsupplyandshowsstrongantiinfectivecapacity.Abductorhallucismusclewithskinflapgraftcanreconstitutelargerareasoftheheelskindefectwithbetterbloodcirculationinskintissuesandfellings.Loadedwalkingdoesnotshowulcerationprone.Peronealarteryislandskinflaptoreconstituteheeldefectdemonstratespoorerfrictionresistanceandulcrerationwhichrequireslong-termofkeratinizingprocessandapproriateprotection.......