第1跖底动脉穿支皮瓣修复躅趾软组织缺损  

A new flap based on the first plantar metatarsal artery perforator for repair of toe soft tissue

作　　者：林涧[1] 郑和平[2] 林加福[3] 谢志平[2] 陆骅[1] 张天浩[1] 王之江[1] 万华俊[1] 

机构地区：[1]上海交通大学医学院附属新华医院(崇明)骨科,202150 [2]南京军区福州总医院骨科研究所 [3]福建卫生职业技术学院医学基础部

出　　处：《中华创伤杂志》2015年第9期833-835,共3页Chinese Journal of Trauma

基　　金：上海市科研计划资助项目（14411973200）;上海市崇明区科技攻关资助项目（CKY2015-05）;南京军区医学科技创新重大资助项目（ZX30）

摘　　要：目的探讨第1跖底动脉穿支皮瓣治疗躅趾软组织的临床效果。方法根据第1跖底动脉穿支的走行、分支及其与躅展肌上缘动脉弓吻合的解剖学特点，以第1跖底动脉穿支浅出点为旋转点，以躅展肌上缘为皮瓣轴线在足内侧设计第1跖底动脉穿支皮瓣，移位修复蹰趾皮肤软组织缺损患者17例，其中男11例，女6例；年龄14—69岁（平均36．5岁）。致伤原因：重物压砸伤9例，交通伤6例，趾甲瓣移植后创面2例。损伤部位：足蹿趾掌侧皮肤缺损3例，趾端皮肤缺损5例，足蹿趾背侧皮肤缺损6例（含2例趾甲瓣移植后趾背缺损），足躅趾侧方皮肤缺损3例。缺损面积为3．0cm×2．2cm～7．5cm×5．5cm。皮瓣切取面积为3．2cm×2．5cm～11．0cm×4．5cm。急诊手术I期修复12例，择期手术Ⅱ期修复5例。结果17例皮瓣均成活，创面I期愈合，经1～38个月随访，皮瓣质地优良、色泽接近正常、外形美观。结论第1跖底动脉穿支皮瓣解剖位置恒定、血液供应良好、手术方法简单，是修复四趾皮肤软组织缺损的可行方法之一。Objective To investigate the clinical effect of first plantar metatarsal artery perforator flap in repair of toe soft tissue defect. Methods According to the course and branches of the first plantar metatarsal artery and its anastomosing correlation with the artery arch of the superior margin of abductor hallucis, a plantar metatarsal artery perforator-based flap was designed to repair soft tissue defect around the hallux. Rotation point of the flap was upon the first metatarsophalangeal joint, and the superior margin of the abductor hallucis was designed as axis of the flap. There were 11 males and 6 females at age of 14-69 years （mean, 36.5 years）. Mechanism of injury was hit by heavy objects in 9 patients, traffic accidents in 2 and wounding after nail flap transplantation in 2. Skin defect located at the palmar toe in 3 patients, toe end in 5, dorsal toe in 6 and lateral toe in 3. Stage ] emergency surgery was performed in 12 patients and selective stage II surgery in 5 patients. Size of defect ranged from 3.0 cm × 2.2 cm to 7.5 cm×5.5 cm. Dimensions of the skin flap ranged from 3.2 cm×2.5 cm to 11.0 cm×4.5 cm. Results All the 17 flaps survived with primary wound healing. Texture, color and appearance of the flaps were satisfactory after a follow-up of 1-38 months. Conclusion With constant anatomic location, sufficient blood supply and easy surgical performance, the first plantar metatarsal artery perforator-based flap can be a good choice in repairing soft tissue defect around the hallux.

关 键 词：足损伤 外科皮瓣 第1跖底动脉穿支 

分 类 号：R658.3[医药卫生—外科学]