足踝部外伤皮肤缺损常用带蒂皮瓣的选择  

Choices of pedicle skin flaps in repairing cutaneous defects of foot and ankle

作　　者：胡勇[1] 李淑媛[1] 孙文海[1] 刘培亭[1] 白龙滨[1] 王增涛[1] 

机构地区：[1]山东大学附属省立医院手足外科,济南250021

出　　处：《中华显微外科杂志》2013年第3期220-224,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨总结足踝部外伤皮肤缺损的特点和常用带蒂皮瓣的选择，并针对修复不同部位皮肤缺损的皮瓣供区选择提供建议和参考。方法采用足背皮瓣、足底内侧皮瓣、跖底皮瓣、躅趾腓侧皮瓣、第2趾胫侧皮瓣、胫前皮瓣、小腿内侧皮瓣、腓肠神经皮瓣、跗外侧皮瓣、踝前皮瓣、腓动脉皮瓣等行带蒂转移修复前足、足背、足底及踝部皮肤缺损。结果术后251例皮瓣除2例坏死外全部成活。5例术后第1天、2例第2天因植皮处包扎过紧，出现血管危象，探查后血运恢复正常。135例随访3～96个月，平均16个月，足底内侧皮瓣有4例、跖底皮瓣3例，转移后出现皮瓣和足底皮肤缝合处的磨损，二期皮瓣修整，改变负重点恢复正常行走。9例小腿内侧皮瓣、6例腓肠神经营养血管皮瓣，因为皮瓣魄肿行二期整形。其余皮瓣无明显臃肿，外形良好，不需要二期整形。其中足底内侧皮瓣和躅趾腓侧皮瓣、第2趾胫侧皮瓣顺行转移均带感觉神经，供区为非负重部位，不影响患者行走及负重功能，术后皮瓣感觉正常，两点辨别觉4～10mm。结论足底内侧皮瓣、跖底皮瓣、跽趾腓侧皮瓣及第2趾胫侧皮瓣修复前足跖侧较好，皮肤耐磨，感觉好；足背皮瓣、胫前皮瓣、小腿内侧皮瓣、腓肠神经营养血管皮瓣、跗外侧皮瓣、踝前皮瓣、腓动脉皮支皮瓣、腓动脉皮瓣等皮瓣可以切取的面积较大，修复足背及踝关节周围皮肤缺损，具有皮瓣较薄、色泽接近和解剖位置恒定等优点。以上皮瓣均操作简单，修复效果好，是修复足踝部皮肤缺损的良好方法。Objective To explore and summarize the choices of pedicle skin flaps in repairing cutaneous defect of foot and ankle. Methods Defects of forefoot, pedal dorsum, pedal plantar and ankle were repaired with pedicle skin flaps such as dorsal pedal flap, medial plantar flap, plantar metatarsal flap, fibular hallux flap, tibial flap of 2nd toe, anterior tibial artery flap, posterior tibial artery flap, sural nerve flap, lateral tarsal artery flap, anterior ankle artery flap peroneal artery flap etc. Results Except for necrosis of 2 cases of flap, the other 249 flaps all survived. Blood vessel crisis was induced in 5 patients on 1st postoperative day, and in 2 cases on 2nd postoperative day, by tight package of transplanted skin, which was treated by emergent explorative operation. Finally 135 cases got 3 to 96 months＇ followed up（ average of 16 months） . There were 4 cases of medial pedal flap and 3 cases of plantar metatarsal flap received secondary reshaping for treating skin wear out. Nine cases of posterior tibial artery flap, and 6 cases of sural nerve flap were reshaped secondarily to improve bulk shape. Other flaps did not need secondary reshaping. Among them, in medial pedal flap, fibular-side flap of hallux, and tibial- side flap of 2nd toe, sensory nerve were all transferred together with the flap, and normal sensory was got, with 4- 10 mm two point discrimination. Conclusion In covering tissue defects on heel or plantar side of forefoot, medial plantar artery flap is ideal. For defects on plantar side of forefoot, plantar metatarsal flap, fibular hallux flap, tibial flap of 2nd toe have the advantages of wear resistance and nerve innervation. While dorsal pedal flap, anterior tibial artery flap, posterior tibial artery flap, sural nerve flap, lateral tarsal flap, anterior ankle arteryflap, and peroneal artery perforator flap have the advantages of large size, thinness, similar color with recipient site, and constant anatomical position, they are feasible for repairing defects on dorsum of foot or near

关 键 词：足 踝 外科皮瓣 移植 显微外科 

分 类 号：R65[医药卫生—外科学]