多穿支共同血管蒂的小腿后外侧“螺旋桨”皮瓣修复足踝部皮肤缺损  

Clinical application of lateral leg multi-perforators pedicled propeller flaps for reconstructing the foot and ankle defects

作　　者：李涛[1] 陈振兵[1] 丛晓斌[1] 艾方兴[1] 周攀[1] 洪光祥[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院手外科,武汉430022

出　　处：《中华显微外科杂志》2015年第4期359-362,共4页Chinese Journal of Microsurgery

基　　金：湖北省自然科学基金（2013CFC40）

摘　　要：目的 探讨以多个穿支为共同血管蒂的小腿后、外侧“螺旋桨”皮瓣修复足、踝部皮肤缺损的方法及临床效果.方法 自2012年5月至2013年6月,共收治足、踝部皮肤缺损的患者8例,包括创伤导致皮肤、软组织缺损5例,慢性溃疡创面2例,关节囊肿破溃后感染引起皮肤坏死1例.以外踝与足跟之间发出的2-3个穿支血管为蒂,均采用小腿后、外侧2-3支穿支作为共同血管、以偏心蒂“螺旋桨”皮瓣的方式修复创面,皮瓣面积15.0 cm × 7.0 cm - 23.0 cm×9.0 cm,供区行游离植皮.术后行显微外科常规治疗及评价.结果 1例皮瓣远端出现宽2.0 cm、长1.0 cm大小的表层皮肤坏死,经换药表层脱痂,在1个月内自行愈合,其余7例皮瓣均完全成活.7例获得有效随访,随访时间7-18个月,平均10.7个月.患者对皮瓣外形满意度高,术后皮瓣感觉神经评级为S3级,患足AOFAS评分平均值为90.5,其中优3例,良4例.结论 以多个穿支为共同血管蒂增大了小腿后、外侧“螺旋桨”皮瓣的安全切取范围,能修复较远距离、较大创面的缺损,是一种安全有效的内增压术式.Objective To investigate the methods and results of lateral leg propeller pedicled flaps based on multi-perforators for coverage of soft-tissue defects on the foot and ankle.Methods From May,2012 to June,2013,8 patients with soft-tissue defects were treated,including 5 cases by trauma,2 cases by chronic unlcers,1 case by infection on the foot and ankle with exposed osseous and tendinous.Lateral leg propeller pedicled flaps based on multi-perforators were elevated and rotated with the angle from 150° to 180° for coverage of soft-tissue de-fects.Flap size ranged from 15.0 cm × 7.0 cm to 23.0 cm × 9.0 cm.Skin graft was applied to cover the donor sites.After the operation,the blood supplies of flaps were observed severely over 10 days.Questionnaire of the flap aesthetic satisfactory and AOFAS evaluation were performed in 7 patients during fellowed-up periods.Results Seven flaps were all survived well,1 flap had partial marginal skin necrosis on the distal,which was managed with surgical debridement,and wound healed in 1 month.Seven patients had a mean of 10.7 months＇ fellowed-up periods.The flaps had like-like appearance,good contour,and high aesthetic satisfactor （100%）.The mean AOFAS score was 90.5.Conclusion Lateral leg propeller pedicled flaps based on multi-perforators can supply the blood of the larger volume of tissue,which can be safely sustained to repair distal and larger defects on the foot and ankle.

关 键 词：足 踝 穿支皮瓣 螺旋桨皮瓣 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]