改良腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损  

The modified peroneal artery perforator-based propeller flap for the reconstruction of distal lower extremity defect

作　　者：唐举玉[1] 卿黎明[1] 吴攀峰[1] 俞芳[1] 梁捷予[1] 符劲飞 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华显微外科杂志》2015年第4期338-341,共4页Chinese Journal of Microsurgery

基　　金：国家自然科学基金面上项目（81472104）

摘　　要：目的 探讨采用不携带腓肠神经和小隐静脉的腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损的可行性和临床效果. 方法 2009年1月至2013年8月,应用不携带腓肠神经和小隐静脉的腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损20例.以超声多普勒确定靠近创面的腓动脉穿支的穿出部位,以其为旋转点,以该点与腘窝中点至外踝与跟腱连线中点连线附近探及的第二穿支点连线为轴线,设计腓动脉穿支螺旋桨皮瓣,皮瓣切取不携带深筋膜、腓肠神经及小隐静脉,保留腓肠神经和小隐静脉周围的营养血管网于皮瓣内.皮瓣供区直接缝合.皮瓣切取面积7 cm×4 cm-21 cm×7 cm. 结果 20例皮瓣全部成活,创面一期愈合.术后随访10-28个月（平均13个月）,皮瓣色泽、质地优良,皮瓣蒂部与供、受区外形满意,穿鞋不受影响,行走功能恢复正常.足外侧感觉与足部静脉回流无影响. 结论 改良的腓动脉穿支螺旋桨皮瓣血供可靠,旋转方便,进一步减少了皮瓣供区损害,改善了皮瓣受区外观,可在临床推广应用.Objective To explore the feasibility and clinical effect of modified peroneal artery perforator- based propeller flap which excludes small saphenous vein and sural nerve for coverage of the soft tissue defects of the ankle and foot. Methods From January, 2009 to August, 2013, 20 patients with soft tissue defects of the foot or ankle underwent the procedures of reconstruction. After the proper perforators being identified with doppler sonography, the propeller flap was designed, which selected the location where terminal perforator vessels perforate deep fascia as the pivot point, the line from this point to the point where the second perforator near the wound around the line from the midpopliteal point to the midpoint of the achilles tendon and lateral malleolus perforated the deep facia as the axis. The flap was raised above the level of the deep fascia. The small extrinsic vessels around the sural nerve and small saphenous vein were contained in the flap, while the small saphenous vein and sural nerve were kept in the original position. The donor site was closed directly. The skin flaps measured from 7 cm × 4 cm to 21 cm × 7 cm. Results All 20 flaps survived completely without complications. During 10-28 months＇ followed-up （average 13 months）, all flaps showed good texture matches and contour. All patients recovered walking and shoe wearing function. No one showed sensory disturbances at the lateral foot. Conclusion The modified peroneal artery perforator-based propeller flap excluding small saphenous vein and sural nerve still has stable blood supply, which is an idea way for covering skin and soft tissue defects in foot and ankle.

关 键 词：足踝部 腓动脉 穿支皮瓣 螺旋桨皮瓣 

分 类 号：R658.3[医药卫生—外科学]