逆行跗外侧动脉皮瓣修复前足皮肤软组织缺损  

REPAIR OF FOREFOOT SKIN AND SOFT TISSUE DEFECT WITH REVERSE LATERAL TARSAL ARTERY FLAP

作　　者：苗卫华[1] 刘振[1] 许超[1] 

机构地区：[1]菏泽市立医院骨科,山东菏泽274000

出　　处：《中国修复重建外科杂志》2010年第1期53-56,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨逆行跗外侧动脉皮瓣修复前足皮肤软组织缺损的手术方法及临床疗效。方法2007年8月-2009年4月,收治前足皮肤软组织缺损11例。男7例,女4例;年龄16～60岁,平均36岁。左足8例,右足3例。其中碾挫伤5例,压砸伤3例,受伤至入院时间4～12h;恶性黑色素瘤扩大切除术后3例,病程3～12个月。创面部位:第1跖趾关节背侧5例,趾背侧2例,跖骨远端背侧4例;创面范围4cm×2cm～6cm×5cm;单纯肌腱外露6例,肌腱缺损合并骨外露4例,肌腱缺损合并跖趾关节开放脱位1例。一期皮瓣修复7例,二期修复4例。于足背外侧设计以足背动脉为蒂的跗外侧动脉皮瓣,以足背动脉足底穿支为旋转点,逆行移位修复前足创面;皮瓣切取范围4.5cm×2.5cm～6.5cm×4.5cm。其中7例将足背外侧皮神经与受区神经残端吻合。供区采用全厚皮片植皮修复。结果术后7d2例皮瓣出现部分皮缘坏死,经换药后皮瓣成活;余9例皮瓣均顺利成活,创面Ⅰ期愈合。供区植皮均顺利成活,切口Ⅰ期愈合。术后患者均获随访,随访时间6个月～2年,平均13个月。皮瓣质地柔软,色泽与周围正常皮肤相似,外观无臃肿、磨损及破溃,患者步态正常。其中7例吻合神经者,术后6个月两点辨别觉为5～12mm;未吻合神经者皮瓣仅恢复部分保护性感觉。结论逆行跗外侧动脉皮瓣厚度适中且耐磨,血管解剖恒定,血管蒂长,管径粗大,血供充分,是修复前足皮肤软组织缺损的良好选择之一。Objective To investigate the operative procedure and the clinical results of reverse lateral tarsal artery flap in treating forefoot skin and soft tissue defect.Methods From August 2007 to April 2009,11 patients with forefoot skin and soft tissue defect were treated with reverse lateral tarsal artery flaps,including 7 males and 4 females aged from 16 to 60 years （36 years on average）.Of 11 cases,defects were caused by crash in 5 cases,by grind contusion in 3 cases and the course disease was 4-12 hours;by tumor extended resection in 3 cases and the disease course was 3-12 months.There were 5 wounds on the dorsum of first metatarsophalangeal joint,2 on the dorsum of the first toes,and 4 on the dorsum of distal part of metatarsal bones.The area of defect ranged from 4 cm×2 cm to 6 cm×5 cm.There were 6 cases of tendon exposure,4 cases of tendon defect with bone exposure,and 1 case of tendon defect with open dislocation of metatarsophalangeal joint.The flap was designed with dorsal artery of foot as its pedicle.The plantar perforating branch was designed as its rotating point.And the flaps were transferred retrogradely to repair the forefoot wounds.The flap area ranged from 4.5 cm×2.5 cm to 6.5 cm×4.5 cm.The lateral dorsal nerve of foot was anastomosed with the nerve in wound area in 7 cases.Donor site was covered by full thickness skin graft.Results Partial necrosis occurred and was cured by dressing change,followed by skin graft in 2 cases.The flaps survived and primary healing was achieved in the other 9 cases.All the skin grafts of donor site survived and primary healing was achieved after operation.All the patients were followed up for 6 months to 2 years,averaged 13 months.The texture and color of the flap were similar to skin at the recipient site.All patients returned to normal in walking and running and no ulceration occurred.The two point discrimination was 5-12 mm 6 months after operation in 7 patients who received nerve anastomosis, while only protective sensation recovered partly in the other 4 pa

关 键 词：逆行跗外侧动脉皮瓣 前足 皮肤软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]