逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝部软组织缺损  

Clinical Application of Reversed Tibialis Posterior Artery Perforator-Based Saphenous Neurocutaneous Flap for Treatment of Skin and Soft Tissue Defect Around the Foot and Ankle Joint

作　　者：陈明[1,2] 文根[2] 吕一鸣[2] 汪春阳[2] 柴益民[2] 

机构地区：[1]苏州大学医学院,江苏苏州215006 [2]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《实用骨科杂志》2012年第3期223-226,共4页Journal of Practical Orthopaedics

摘　　要：目的报道逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝关节周围软组织缺损的手术方法和临床效果。方法对48例足踝关节周围皮肤软组织缺损的患者采用逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复,单纯逆行胫后动脉穿支蒂隐神经营养血管皮瓣39例,肌皮瓣9例;其中胫后动脉穿支筋膜蒂神经营养血管皮瓣29例,胫后动脉穿支血管蒂营养血管皮瓣19例,软组织缺损大小12 cm×9 cm^4 cm×3 cm,皮瓣面积13 cm×9.5cm^6 cm×5 cm。结果 43例皮瓣完全存活,5例皮瓣远端部分坏死,经积极换药、清创植皮修复。皮瓣术后轻度肿胀,无感染及淤血,皮瓣蒂部无臃肿。术后随访6~18个月,皮瓣质地优良,肢体外形与功能恢复满意,供区植皮术后恢复保护性感觉。结论胫后动脉穿支蒂隐神经营养血管皮瓣血供可靠,质地优良,是修复足踝关节周围软组织缺损的良好选择。Objective To discuss clinical application of reversed tibialis posterior artery perforator-based saphe- nous neurocutaneous flap for treatment of skin and soft tissue defect around the foot and ankle joint. Methods 48 pa- tients had been treated with perforator-based saphenous neurocutaneous flap for repairing skin and soft tissue defect around the foot and ankle joint. Simple reversed tibialis posterior artery perforator-based saphenous neurocutaneous flap was applied in 43 cases;musculoeutaneous flap was applied in 5 cases. There are 29 fascial-perforator-based saphenous neurocutaneous flaps and 19 perforator-based saphenous neurocutaneous flaps. The area of soft tissue de- fects ranged from 10 cm×9 cm to 4 cm× 3 em. The area of flaps ranged from 11 cm×9.5 cm to 6 cmX5 cm. Results 43 flaps survived completely;5 flaps encountered partial necrosis of distal portion,were treated by dressing change or secondary skin graft. All flaps were slightly swelling postoperatively without congestion. All the patients have been followed up for 6 to 18 months. The cosmetic appearance and texture of flaps were satisfied without corpulenced pedi- cle,the protective sensation was renewed in donor site after transplanting cellulocutaneous flap. Conclusion Reversed tibialis posterior artery perforator-based saphenous neurocutaneous flap with reliable in blood-supply and modest tex- ture is a good option for repair of skin and soft tissue defect around the foot and ankle joint.

关 键 词：隐神经营养血管皮瓣 穿支皮瓣 移植 踝关节 显微外科 

分 类 号：R622.1[医药卫生—整形外科]