小趾展肌肌瓣的临床应用  

CLINICAL APPLICATION OF ABDUCTOR DIGITI MINIMI MUSCLE FLAP

作　　者：褚会军[1] 牛志强[1] 刘文章[1] 焦弘升[1] 于景川[1] 郭家全[1] 

机构地区：[1]冀中能源峰峰集团总医院骨六科,河北邯郸056200

出　　处：《中国修复重建外科杂志》2011年第7期808-810,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨小趾展肌肌瓣修复足部偏外侧及足跟部皮肤软组织缺损的手术方法及临床疗效。方法 2002年7月-2010年10月,收治8例足部偏外侧及足跟部皮肤软组织缺损患者。男6例,女2例;年龄28～65岁,平均42岁。左足5例,右足3例。足跟部溃疡2例,跟骨骨折术后切口愈合不良致肌腱、内固定物外露1例,碾挫、挤压伤致足部偏外侧皮肤软组织坏死5例。软组织缺损范围为1.5 cm×1.0 cm～8.0 cm×2.6 cm。病程30 min～26个月。2例细菌培养呈阳性。入院后清创换药9～15 d,待感染控制后采用大小为5.6 cm×1.5 cm～7.6 cm×1.8 cm的小趾展肌肌瓣移位修复创面。供区直接缝合。结果术后7例小趾展肌肌瓣顺利成活;1例术后4 d发生肌瓣部分坏死,对症治疗后肉芽生长良好。供区切口均Ⅰ期愈合。9～21 d肌瓣表面新鲜肉芽生长良好,取小腿内后侧刃厚皮片游离移植修复肌瓣创面。一期皮片游离移植修复肌瓣创面1例,二期修复7例;修复术后皮片均成活,创面Ⅰ期愈合。术后7例获随访,随访时间9～18个月,平均11个月。创面外形、质地和感觉恢复满意。两点辨别觉为16～23 mm,平均19.5 mm。1例足跟部溃疡患者负重行走出现表皮磨损。1例术前腓骨长、短肌腱部分坏死者出现足外翻、肌力下降,其余患者关节功能正常。结论采用小趾展肌肌瓣移位修复足部偏外侧及足跟部皮肤软组织缺损具有手术操作简便,安全可靠,对供区损伤小,不影响负重,创面外形、弹性好,感觉恢复好的优点,疗效满意。Objective To discuss the surgery procedure and the clinical effectiveness of repairing skin and soft tissue defects in the lateral foot and the heel with the abductor digiti minimi muscle flap. Methods Between July 2002 and October 2010, 8 patients with skin and soft tissue defects in the lateral foot and the heel were treated. There were 6 males and 2 females with an average age of 42 years （range, 28-65 years）. The locations were the left foot in 5 cases and the right foot in 3 cases. Defects were caused by ulcer of the heel in 2 cases, by poor healing of incision after calcaneus fracture surgery in 1 case, and by crushing in 5 cases. The defect size ranged from 1.5 cm × 1.0 cm to 8.0 cm × 2.6 cm. The disease duration was 30 minutes to 26 months. The result of bacterial culture was positive in 2 cases. After 9 to 15 days of debridement and dressing change, defects were repaired with the abductor digiti minimi muscle flap of 5.6 cm × 1.5 cm to 7.6 cm × 1.8 cm at size. The donor sites were sutured directly. Results Partial necrosis of muscle flap occurred in 1 case at 4 days after operation, which was cured by symptomatic treatment, and the other muscle flaps survived. All incisions of the donor sites healed by first intention. The muscle flaps survived and the granulation grew well at 9-21 days after operation, and the muscle flap wounds were repaired by free leg edge thickness skin grafting. Wounds were repaired by one-stage free skin grafting in 1 case and by two-stage free skin grafting in 7 cases; all skin flaps survived and wounds healed by first intention. Seven patients were followed up 9-18 months （mean, 11 months）. The appearance, texture, and sensation were satisfactory. The two-point discrimination was 16-23 mm （mean, 19.5 mm）. Epidermal abrasion occurred in 1 case of heel ulcer after weigt-bearing walking. Hallux valgus and muscle weakness occurred in 1 case of necrosis of the peroneus length tendons; and the satisfactory results were achieved in the other patients. Conclusion It has

关 键 词：小趾展肌肌瓣 足跟部溃疡 足跟部软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]