外踝上穿支蒂腓浅神经营养血管皮肤筋膜瓣修复足背皮瓣供区  

Superficial peroneal neurocutaneous vascular axial adipofascial-cutaneous flap pedicled with lateral supramalleolar perforator for coverage of donor site defects at foot dorsum

作　　者：陈雪松[1] 徐永清 陈建明[3] 王元山[3] 管力[3] 余晓军[3] 许建明[3] 李彦林[1] 

机构地区：[1]昆明医科大学第一附属医院骨科,650032 [2]解放军昆明总院全军骨科中心 [3]解放军第五十九医院成都军区战创伤显微外科中心

出　　处：《中华整形外科杂志》2013年第5期345-348,共4页Chinese Journal of Plastic Surgery

摘　　要：目的 探讨螺旋桨状腓浅神经营养血管皮肤筋膜瓣修复足背皮瓣供区的方法及效果.方法 对足背皮瓣切取后供区创面,设计以外踝上穿支为蒂,通过皮下筋膜层扩大切取的腓浅神经营养血管皮肤筋膜瓣（皮肤宽度4～6 cm）旋转180.修复；供区直接拉拢缝合,受区皮下筋膜层表面一期或二期移植皮片修复.结果 2007年5月至2011年10月临床应用7例,皮肤筋膜瓣最大切取面积30 cm×11 cm,最小19 cm×8 cm,皮瓣均全部成活.术后随访9～ 23个月,足踝外形及功能恢复满意,可正常穿鞋行走；修复手背皮肤肌腱联合缺损的足背趾长伸肌腱皮瓣全部成活,至少部分恢复主动伸指功能（2例进行了二期肌腱松解术）.结论 该皮瓣血供确切,旋转修复距离足够,小腿供区仅留线状缝合瘢痕,适用于不同面积足背皮瓣切取后供区创面的修复.Objective To report the operative techniques and clinical results of modified superficial peroneal neurocutaneous propeller adipofascial-cutaneous flap for reconstruction of donor site defects at foot dorsum.Methods A propeller adipofascial flap with a skin pedicle（4-6 cm in width） based on the lateral superamalleolar perforating artery which vascularized the flap through the nutrient vessel chain of the superficial peroneal nerve was designed to repair defects after harvesting of foot pedicled dorsal flap.The defects at donor site of the leg was closed directly and split-thickness skin grafting was performed on the adipofascial surface of the flap primarily or secondarily.Results From May 2007 to Oct.2011,7 cases were treated.All flaps were transplanted successfully with satisfactory cosmetic and functional results.The flaps size ranged from 19 cm × 8 cm to 30 cm × 11 cm.Conclusions The flap has reliable blood supply with a relatively large vascularized area,long rotation arc and minimum donor-site cosmetic morbidity.It＇ s a simple and safe procedure which is suitable for covering donor sites defects after harvesting foot pedicled dorsal flap.

关 键 词：外科皮瓣 皮神经营养血管 供区 

分 类 号：R658.3[医药卫生—外科学]