胫后动脉穿支皮瓣与腓肠神经营养血管皮瓣修复小腿远端创面的效果比较  

Comparison between posterior tibial artery perforator flaps and sural flaps for reconstruction of foot, ankle and distal lower leg.

作　　者：周钢[1] 邱勋永[1] 王快胜[1] 马心赤[1] 王和驹[1] 

机构地区：[1]海南省人民医院骨科,海南海口570311

出　　处：《海南医学》2013年第9期1293-1296,共4页Hainan Medical Journal

摘　　要：目的比较胫后动脉穿支皮瓣与腓肠神经营养血管皮瓣修复小腿远端及足踝部分软组织缺损的术后患处外观及功能改变。方法 2009年8月至2012年2月收治52例足、踝以及远端小腿皮肤软组织缺损患者,使用胫后动脉穿支皮瓣修复25例,腓肠神经营养血管皮瓣修复27例,术后对并发症发生率进行统计,并于术后6个月复查时使用改良Weber临床缺陷评分系统对患肢的功能进行评估。结果微小皮瓣坏死(<10%)发生率:胫后动脉穿支皮瓣为8.7%,腓肠神经营养血管皮瓣为12.0%;部分皮瓣坏死(≥10%)发生率:胫后动脉穿支皮瓣为8.7%,腓肠神经营养血管皮瓣为4.0%。完全坏死仅腓肠神经营养血管皮瓣组发生2例。改良Weber临床缺陷评分:胫后动脉穿支皮瓣组(6.17±1.35)分,腓肠神经营养血管皮瓣组(8.92±1.73)分,但仅在"肿胀"项评分比较中具有统计学意义(P<0.05)。结论胫后动脉穿支皮瓣术后受区外观较好,对供区功能改变影响较小,而术后发生坏死的风险也并不高于传统的腓肠神经营养血管皮瓣,因此可以作为小腿远端、足、踝部分中、小面积皮肤软组织缺损的首选治疗方案。Objective To compare cosmetic and functional outcome following transfer of posterior tibial ar- tery perforator flaps and sural flaps for reconstruction of foot, ankle and distal lower leg. Methods Fifty-two patients with skin defects of the foot, ankle and distal lower leg from August 2009 to February 2012 were enrolled in this study, of which 25 were treated with posterior tibial artery perforator flaps and 27 with sural flaps. The incidence of postoperative complications were observed, and the leg function of patients was evaluated 6 months after treatment us- ing modified Weber scale. Results Minor flap necrosis （〈10%） was observed in 8.7% of the posterior tibial artery perforator flaps and 12.0% of the sural flaps, and partial necrosis （≥ 10%） was observed in 8.7% of the posterior tibial artery perforator flaps and 4.0% of the sural flaps. Total flap loss only occurred in 2 patients following transfer of sural flaps. Although the mean total score of the modified Weber scale of the posterior tibial artery perforator flaps was low- er, but the difference was only significant in the Swelling subscale. Conclusion The incidence of flap necrosis and the morbidity in the donor of the posterior tibial artery perforator flaps was not greater than sural flap, but the former has a better aesthetic. The posterior tibial artery perforator flap should be recommended for reconstruction of small-to medium-sized defects at the foot, ankle and distal lower leg.

关 键 词：下肢软组织缺损 胫后动脉穿支皮瓣 腓肠神经营养血管皮瓣 创面修复 

分 类 号：R687.1[医药卫生—骨科学]