腓动脉穿支皮瓣游离移植修复前足创面的临床应用  

Clinical application of free peroneal artery perforator flap transplantation for forefoot defects reparation

作　　者：官士兵[1] 寇伟[2] 许兰伟[1] 赵雁[1] 

机构地区：[1] 山东省立医院手足外科, 济南250021 [2] 济南市中医医院骨科

出　　处：《中华显微外科杂志》2014年第4期356-359,共4页Chinese Journal of Microsurgery

摘　　要：目的 分析小腿外侧腓动脉穿支皮瓣的特点,探讨腓动脉穿支皮瓣游离移植修复前足创面的临床应用. 方法 回顾性分析小腿外侧腓动脉穿支皮瓣游离移植修复前足创面患者9例,皮肤缺损面积为4.5 cm×4.0cm～13.5 cm×6.5 cm;着重分析前足创面的特点以及小腿外侧腓动脉穿支皮瓣的设计、切取、血管吻合匹配等,术后随访皮瓣的成活、外观及踝足的功能恢复情况等. 结果 9例均在小腿外侧以腓骨小头与外踝连线中点稍上方附近找到发自腓动脉的较大肌皮穿支,且有明显的2条静脉伴行.移植皮瓣静脉修复：1例腓动脉穿支动脉伴行静脉-足（跖）背动脉伴行静脉端端吻合2条,5例腓动脉穿支动脉伴行静脉-足（跖）背动脉伴行静脉端端吻合1条;3例腓动脉穿支动脉伴行静脉-足（跖）背动脉伴行静脉端端吻合1条加腓动脉穿支动脉伴行静脉-足背浅静脉端端吻合1条.术后9例皮瓣全部成活,未发生血管危象,修复1条静脉与修复2条静脉皮瓣肿胀情况肉眼观察无明显差异;受区、供区创面均一期愈合;术后随访2～6个月,1例因皮瓣臃肿术后5个月行皮瓣整形,其他皮瓣皮肤质地、颜色满意. 结论 小腿外侧腓动脉穿支皮瓣游离移植摆脱了带蒂皮瓣的束缚,使手术设计和实施相对自由,对皮瓣供区、受区的创伤均得到有效控制.该皮瓣的血管解剖相对稳定、血供可靠、切取简单、皮肤质地与足部接近修复效果好、供区受区可在同一麻醉同一个止血带下完成,是修复前足部创面一个很好的选择.Objective To analyze features of the lateral leg peroneal artery perforator free flap,and study the clinical application of free peroneal artery perforator flap transplantation for repairing forefoot defects.Methods Retrospectively analyzed 9 patients with forefoot defects which had been repaired with free lateral leg peroneal artery perforator flap transplantation.In this group,the skin and soft tissue defects size were 4.5 cm ×4.0 cm-13.5 cm × 6.5 cm,Focused on analyzing the features of forefoot skin and soft tissue defects,the design and harvesting of lateral leg peroneal artery perforator flap,and vascular anastomosis and vessel matching,meanwhile,follow-up the survival condition and appearance of the flap,the function of foot and ankle after operation.Results In the 9 cases,the larger myocutaneous perforator arising from peroneal artery,accompanying 2 vena comitans,were found slightly above the midpoint of the line between fibula head and lateral malleolus in lateral leg.The flaps transfered to repair forefoot defects,artery end-end anastomosis：in 5 cases cutaneous branch of peroneal artery to dorsal artery of foot,in 4 cases by cutaneous branch of peroneal artery to dorsal metatarsal artery;vein end-end anastomosis：in 1 case 2 accompanying veins of peroneal artery cutaneous branch to 2 accompanying veins of dorsal artery of foot,in 5 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,in 3 cases 1 accompanying vein of peroneal artery cutaneous branch to 1 accompanying vein of dorsal artery of foot or metatarsal,simultaneously,the another accompanying vein of peroneal artery cutaneous branch to 1 dorsal superficial vein of the foot.All the 9 flaps survived,and no vessel articulo happened.The venous return of flaps had no significant difference between repairing 1 vein and 2 veins in gross appearance.All wounds healed in one-period.Followed-up 2-6 months postoperative,1 patient was performed flap reshaping due to flap fat and clumsy

关 键 词：前足 腓动脉穿支皮瓣 移植 

分 类 号：R658.3[医药卫生—外科学]