吻合血管的腘动脉皮支皮瓣修复足踝部创面  

FREE VASCULARIZED POPLITEAL ARTERY CUTANEOUS BRANCH FLAP FOR REPAIR OF WOUND ON FOOT AND ANKLE

作　　者：申立林[1] 宋素萍[1] 蔺翠霞[1] 李文龙[1] 孙雪生[1] 朱涛[1] 李强[1] 

机构地区：[1]泰山医学院附属莱芜医院骨二科,山东莱芜271100

出　　处：《中国修复重建外科杂志》2014年第1期88-91,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的通过解剖观测及临床应用探讨游离腘动脉皮支皮瓣与跗外侧动、静脉吻合修复足踝部创面的可行性及疗效。方法取8具尸体下肢标本乳胶灌注血管后,在小腿外后上方行穿支血管解剖研究,设计腘动脉皮支皮瓣,其蒂部切取长度2.5 cm;解剖足部跗外侧动脉并游离至距起始处6 cm处;测量以上血管管径,计数伴行静脉。2010年3月-2013年1月,采用大小为6.0 cm×4.0 cm^7.5 cm×5.5 cm的游离腘动脉皮支皮瓣与跗外侧动、静脉吻合修复13例足踝部创面。男11例,女2例;年龄41~65岁,平均47.3岁。致伤原因:交通事故伤8例,压砸伤4例,机器绞伤1例。创面范围为5.0 cm×3.5 cm^7.0 cm×5.0 cm。供区直接缝合。结果解剖观测结果示,以腘窝外侧动脉穿支为轴,可以设计腘动脉皮支皮瓣,腘动脉皮支皮瓣蒂部穿支管径与跗外侧动脉匹配。临床应用结果示,术后2例皮瓣发生血管危象,经对症处理后成活;其余皮瓣均顺利成活,创面Ⅰ期愈合。供区切口均Ⅰ期愈合。患者均获随访,随访时间5~18个月,平均11个月。术后皮瓣颜色接近正常肤色、质地柔软;其中3例女性患者因皮瓣外形较臃肿行二期皮瓣修薄术,其余患者皮瓣外形均无明显臃肿。术后6个月,踝关节功能采用美国矫形足踝协会(AOFAS)评分:获优7例,良5例,可1例,优良率92.3%。结论游离腘动脉皮支皮瓣与跗外侧动、静脉吻合修复足踝部创面具有手术操作简便、供区隐蔽等优点。Objective To investigate the feasibility and effectiveness of free popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein for the repair of wound on the foot and ankle by anatomical observation and clinical application. Methods Latex was poured into the blood vessels of 8 cadavers, then perforator vessel of posterolateral upper calf was dissected, and the popliteal artery cutaneous branch flap was designed with a pedicle of 2.5 cm in length; the lateral tarsal artery of the foot was dissected, could be freed to 6 cm in length; the diameter of these vessels was measured, and the number of the accompanying veins was counted. Between March 2010 and January 2013, 13 cases of foot and ankle wounds were repaired with popliteal artery cutaneous branch flap anastomosed with lateral tarsal artery and vein. The size of flaps ranged from 6.0 cm × 4.0 cm to 7.5 cm × 5.5 cm. There were 11 males and 2 females, aged from 41 to 65 years （mean, 47.3 years）. The causes of injury included traffic accident in 8 cases, crushing in 4 cases, and twist by machine in 1 case. The size of wounds, ranged from 5.0 cm × 3.5 cm to 7.0 cm × 5.0 cm. The donor sites were sutured directly. Results According to anatomical observation, the popliteal artery cutaneous branch flap was designed by using the lateral popliteal artery perforator for shaft. The vessel of the pedicle perforator flaps from the popliteal artery cutaneous branch flap matched well with the lateral tarsal artery. Clinical results： vascular crisis occurred in 2 flaps, which survived after symptomatic treatment; the other flaps survived, with primary healing of wound and incision at donor site. The patients were all followed up 5-18 months （mean, 11 months）. The flap had normal color and good elasticity. Second stage operation was performed to make the flap thinner in 3 female patients because of bulky flaps. The remaining patients had no obvious fat flap. According to American Orthopaedic Foot and Ankle Society （AOFAS） score for ev

关 键 词：胭动脉皮支皮瓣 跗外侧动 静脉 足踝部创面 创面修复 

分 类 号：R622[医药卫生—整形外科]