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Objective: introduced sural nerve fascia flap improvement the cut method (Shunni method) and distal sural nerve with fascia and subcutaneous tissue flap fasciocutaneous flap application of the sural nerve fascia flap partial necrosis factors were analyzed. Method: April 2001 to April 2008, 111 patients with distally based sural nerve fascia flap 114 cases, of which three patients underwent bilateral sural nerve fascia flap. 88 male and 23 females. The trauma caused 96 cases of skin and soft tissue defects, unstable affixed to the bone scar, scar contracture, chronic ulcerative lesions, tumors treated legacy wound 15 cases are associated with bone, joint, tendon, or Achilles tendon exposed. Repair the defect site: Achilles tendon, calcaneal area in 78 cases, 36 cases of the calf in the next paragraph and the dorsum of the foot. Flap size 5cm x 4cm to 20cm x 15cm. The Retrograde cut flap 36 cases, good times or bad combination method (ie, first revealed fascial pedicle perforating branches of the peroneal artery interval, and then to Retrograde cut flap) cut a flap 78 cases after July 2005. Line remote with fascia and subcutaneous tissue flap sural nerve fascia flap repair associated with skin and soft tissue defect cavity formed 17 cases, the flap distal carrying fascia and subcutaneous tissue flap is used to fill the cavity. Lower leg length (lateral malleolus tip to the distance of the stripes and the midpoint of the popliteal fossa) is divided into 9 equal parts, the flap position in which the calf partition location for the flap far pedicle end (distal flap transposition); flap The aspect ratio (flap plus fascia long) width / fascia. Using a statistical analysis of the handling of the sural nerve fascia flap partial necrosis rate factors (gender, age, defect, lesions, flap rotation point location, flap length plus fascia pedicle length, flap length and width than flap location, flap width, fascia aspect ratio) for analysis. Statistical analysis: Univariate analysis using two independent samples t-test and two 2 × 2 tables x ~ 2 test; multivariate analysis using logistic regression analysis. Results: Of the 114 flaps survived 87 cases; remote epidermis or superficial necrosis of the 13 cases, 10 were treated with dressing, two cases of skin grafts, wound healing in cases of secondary suture; distal partial necrosis 13 cases, 5 patients were given skin grafts, three cases of secondary suture, two cases of dressing, wound healing one cases of medial malleolus flap coverage one cases diagnosed due to the flap after surgery for squamous cell carcinoma and amputation, one case of infection the wound did not heal; 1 cases thromboangiitis obliterans patients, most of flap necrosis, underwent amputation. Either locally or internationally binding assay cut after flap partial necrosis rate (7.7%, 6/78) than the retrograde cut flap partial necrosis rate (22.2%, 8/36). The remote with fascia and subcutaneous tissue flap 17 cases of the sural nerve fascia flap survived completely in 14 cases, distal superficial necrosis and necrosis of the distal portion of the three cases, dressing (1 case), skin grafting (1) malleolus flap coverage (n = 1), wound healing; 17 flaps after surgery were followed up for 1 to 26 months, all flaps satisfactory appearance without recurrence, infection control, no chronic ulcers and pressure sores formation. Sural nerve fascia flap necrosis rate of influencing factors: the width of the flap, the aspect ratio of the flap, flap position. The width of the flap survival group (8.17 ± 2.37cm) is less than the part of the the necrosis group of flaps width (9.79 ± 1.96cm) (p <0.05); flap of the aspect ratio of <5:1 partial necrosis rate (4.84 %, 3/62) is lower than the the ≥ 5:1 set of partial necrosis rate (21.15%, 11/52) (P = 0.005); the flap cut range ≤ 7/9 group partial necrosis rate (2.04%, 1 / 49) below the flap cut> 7/9 group partial necrosis rate (20.00%, 13/65) (P = 0.009); the flap position ≤ 8/9 groups of partial necrosis rate (8.60%, 8 / 93) below the flap position> 8/9 partial necrosis rate (28.57%, 6/21) (P = 0.032). Conclusions: (1) good times or bad method the cut flap can accurately locate the interval perforating branches of peroneal artery, if necessary, adjust the position of the flap in a timely manner, reduce flap necrosis rate, especially for color Doppler positioning line or unconditional line wear branch. (2) distal sural nerve fascia with fascia and subcutaneous tissue flap flap applicable to heel wound; cavitation control wound infection, better retention heel advantages of weight-bearing surface. (3) with increasing the aspect ratio of the cut flap partial necrosis rate increase accordingly; flap aspect ratio of less than 5:1, survived more reliable. The position of the flap far pedicle end closer to the proximal leg, and in part to the higher rate of necrosis; far pedicle flap side cut to the calf on 8/9 8/9), survival is more reliable or less (including. The two factors can play a guiding role to predict the survival rate of the flap.
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