“双翼”带蒂穿支皮瓣修复踝周多创面的设计与临床应用  

Design and clinical application of pedicled perforator flap with double-vane to repair the multiple wounds in the ankle

作　　者：王剑利[1] 赵刚[1] 王根[1] 曲新强[1] 郭永强[1] 付磊[1] 孙圣亮 刘兴龙[1] 张龙[1] 

机构地区：[1]解放军第八十九医院全军创伤骨科研究所,山东省潍坊市261021

出　　处：《中华显微外科杂志》2015年第2期111-115,共5页Chinese Journal of Microsurgery

基　　金：全军“十二五”重点课题（BJN13J001）

摘　　要：目的 探讨“双翼”穿支皮瓣在踝周皮肤软组织缺损显微外科修复的方法和临床疗效. 方法 对7例小腿下1/3至内、外踝及足跟周围慢性创面采用小腿局部2个带蒂穿支皮瓣组合成“双翼”状覆盖多个创面的方法修复,其中4例为胫腓、骨中下段开放骨折（GustiloⅢb或GustiloⅢc型）,2例踝关节开放性骨折并脱位,1例闭合Pilon骨折术后皮肤坏死导致的创面.7例均为多个不规则较小创面,2个创面3例,3个以上创面4例,平均5.7 cm× 2.4 cm.采用小腿后内侧（PM）与前外侧（AL）组合穿支皮瓣组合（PM加AL）2例、后外侧（PL）与后内侧组合（PL加PM）3例;后侧（P）与内侧（M）或外侧（L）组合（P加M或L）2例. 结果 术后7例全部成活,3例术后1周内皮瓣肿胀达2级,5～7d后恢复到正常张力,2例出现皮瓣远端水泡、皮缘瘀紫,10 ～ 14 d逐渐消退.1例术后遗留窦道渗出延迟30余天愈合.随访7～26个月,平均11.5个月.皮瓣外观无臃肿,色泽质地良好.术后6个月,皮瓣两点辨别觉为7～ 14 mm,平均12 mm;按美国AOFAS标准评价：优5例,良2例.功能恢复满意. 结论 组合应用“双翼”皮瓣修复足踝部2个以上小创面或单一较大创面,解决了多个缺损同时覆盖的难题且成功率高,是踝周多创面覆盖修复较理想的方法。Objective To explore the microsurgical treatment and clinical effects of double-vane perforator flaps on the skin and soft tissue defects in the ankle.Methods These chronic wounds of 7 cases were all in the areas from the lower 1/3 of shin to malleolus and heel.Among them,4 cases were open fractures of tibiofibula and lower portion （Gustilo Ⅲb or Gustilo Ⅲc）,2 cases were open fracture and dislocation of ankles,and 1 case was the postoperative wound of skin necrosis caused by closed Pilon fracture.There were multile small and irregularly shaped wounds in these 7 cases,and there were two wounds in 3 cases,in addition,there were more than 3wounds in 4 cases,and the mean area was 5.7 cm × 2.4 cm.Two pedicled perforator flaps of shins constituting double-vane shaped flaps were applied to cover wounds,and these constitutions such as posteromedial and anterolateral perforator flaps （2 cases）,posterolateral and posteromedial perforator flaps （3 cases） and posterior and medial or lateral perforator flaps （2 cases） were designed.Results These 7 flaps all survived after operation,and 3 flaps swelled up to the second degree 1 week after operation and recovered to normal tension after 5 to 7 days.The distal end of two flaps blistered and skin edges appeared purple color,and these symptoms degraded after 10 to 14 days.One sinus was left over and exuded so that it delayed union after 30 days.The follow-up period ranged from 7 months to 26 months,and the average period was 11.5 months.The flaps appeared well with good texture.Six months after operation,two-point discrimination was from 7 mm to 14 mm,and the average was 12 mm.According to AOFAS standard,5 cases were excellent,and 2 cases were good.The recovery of function was satisfactory.Conclusion The blood supply of pedicled perforator flap is rich,and the operation is relatively easy.The application of assembling double-vane flaps to repair more than two small wounds or one large wound solves difficulties that multiple defects can be covered simultaneousl

关 键 词：穿支皮瓣 足踝 软组织缺损 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]