足底深支为蒂带趾短伸肌的逆行足背岛状皮瓣修复前足缺损  

Coverage of tissue defect of forefoot by retrograde dorsalis pedis flap with extensor digitorum brevis pedicle with plantaris profundus

作　　者：李子华[1] 刘有玉[1] 黄雪松[1] 邱忠朋[1] 张兆毅[1] 

机构地区：[1]中国医科大学辽阳中心医院,辽宁辽阳111000

出　　处：《中国医药导报》2010年第5期159-160,共2页China Medical Herald

摘　　要：目的:探讨以足底深支为蒂带趾短伸肌的逆行足背岛状皮瓣修复前足软组织缺损的手术方法及临床疗效。方法:对15例前足软组织缺损的患者应用该皮瓣修复。其中,9例急诊一期手术,6例二期手术治疗,均保留伤足的跖趾关节。皮瓣切取面积为6cm×8cm～12cm×18cm。该岛状皮瓣以足底深支为蒂,并包含趾短伸肌、足背动脉及其分支跗外侧动脉和弓状动脉。术中将足背皮神经与趾神经缝合。皮瓣供区应用全厚皮片植皮修复。结果:二期手术患者中4例出现皮瓣远端部分坏死,经换药愈合。一期手术患者皮瓣均完全成活。术后随访6～12个月,平均10.5个月。皮瓣质地、外形满意,恢复了保护性感觉功能,而且皮瓣耐磨,无溃疡发生,不妨碍行走。结论:在保留跖趾关节同时以足底深支为蒂带趾短伸肌的逆行足背岛状皮瓣修复前足软组织缺损能够最大程度地恢复伤足功能。皮瓣切取面积较传统更大。该皮瓣是一种安全、有效的理想手术方式,特别是急诊一期手术疗效更佳。Objective： To report the surgical technique and clinical outcome of applying retrograde dorsalis pedis flap with extensor digitorum brevis pediele to repair soft tissue defect of forefoot. Methods： 15 cases of soft tissue defect of forefoot were treated with this flap. The primary operations were performed in 9 cases, and the secondary operations in 6 cases. The size of flaps ranged from 6 cm×9 cm-12 cm×18 cm. The metatarsophalangeal joins were preserved. The flaps were brased on plantaris profundus and contained extensor digitorm brevis, dorsalis pedis artery, lateral tarsal artery and arcuate artery. The cutaneous nerve included in the flap was sutured with the proper digital nerve. Donor sites were covered by full thickness skin graft. Results： The necrosis in distal part of the flaps were occurred in 4 cases of secondary operation which healed through changing of dressing. The other flaps survived. All cases were followed up from 6 months to 12 months with an average of 10.5 months. The flaps had satisfactory texture and shape. Protective sensation of flaps were recovered. The flaps were durable. It did not disturb walking and was free of ulceration. Conclusion： Retrograde dorsalis pedis flaps with extensor digitorum brevis pedicle with plantaris profundus meanwhile preserving metatarsophalangeal join is an ideal method to repair the soft tissue defect of forefoot. This procedure can best protect the function of wounded foot. And the flap can be dissected more extensive area, especially outcome of primary operation is the best.

关 键 词：软组织缺损 前足 足背皮瓣 治疗效果 

分 类 号：R622.1[医药卫生—整形外科]