胫后动脉穿支蒂双叶皮瓣修复手部多区域皮肤软组织缺损  

Free transplantation of the bilobed skin flap based on the perforator of the posterior tibial artery for reconstruction of multi-area skin tissue defects in hand

作　　者：周明武[1] 李扬[2] 朱杰[1] 张迅[2] 宋力[1] 王飞云[1] 幸超峰[1] 李士民[1] 

机构地区：[1]解放军第153中心医院全军创伤骨科中心,郑州450007 [2]新乡医学院

出　　处：《中华显微外科杂志》2015年第6期535-538,共4页Chinese Journal of Microsurgery

基　　金：河南省科技攻关重点项目（102102310002）;济南军区后勤科研计划课题（CJN10L062）

摘　　要：目的 探讨胫后动脉（PTA）穿支蒂双叶皮瓣修复手部多区域皮肤软组织缺损的临床应用效果.方法 2012年3月至2014年12月,对手部多区域皮肤软组织缺损患者,术前行小腿PTA彩色多普勒血流成像（CDFI）检查,追踪其穿支起始部位、走行方向及穿支分出的次级分支走行与分布.根据受区皮肤缺损面积,选择其中管径及蒂部长度合适的单一PTA穿支血管为蒂,分别切取以该穿支次级分支为血供的穿支蒂双叶皮瓣,游离移植修复手部多区域皮肤缺损.临床应用5例,皮瓣切取面积为2.5 cm×3.0 cm～ 6.0 cm×8.0 cm.结果 随访3～18个月,皮瓣外形、色泽尚可,质地、弹性好,其中,6处穿支分支皮瓣与周围组织几乎相平,4处穿支分支皮瓣不同程度臃肿,经二期去脂整形后与周围组织平齐.手部外形及功能均较满意,按照中华医学会手外科学分会上肢部分功能评定试用标准评定：优4例,良1例. 结论 应用单一PIA穿支蒂双叶皮瓣修复手部多区域皮肤软组织缺损,不牺牲知名血管,供区影响小,受区恢复好,是一种较为理想的修复方法.Objective To investigate the clinical application effect of the bilobed skin flap based on the perforator of the posterior tibial artery （PTA） for reconstruction of multi-area skin tissue defects in hand.Methods From March, 2012 to December, 2014, the legs of 5 patients with multi-area skin tissue defects in hand accepted color doppler flow imaging （CDFI） to track the origin and direction of the perforator of the posterior tibial artery and direction of secondary branches of the perforator.According to the area of skin defect, the bilobed skin flap based on the right single perforator of posterior tibial artery was designed and cut out.The bilobed skin flap based on the perforator repaired multi-area skin tissue defects in hand.There were 5 cases, and the size of skin flaps ranged from 2.5 cm × 3.0 cm to 6.0 cm × 8.0 cm.Results Followed up for 3 to 18 months, the appearance,color, texture and elasticity of the bilobed skin flaps were good.Six cases of all flaps were flat with the surrounding tissue and others bloated, but they were flat with the surrounding tissue after second phase to fat plastic.The shape and function of the injured hand were satisfactory.According to the related evaluation criteria made by the Chinese Medical Association, the results of 5 cases of hand trauma patients were excellent in 4 cases, good in 1 case.Conclusion Application of the bilobed skin flap based on the perforator is an ideal method to repair multi-area skin tissue defects in hand.Because this kind of surgery doesn＇t sacrifice known vessels with minimal donor site morbidity, and the district restores.

关 键 词：胫后动脉 穿支 双叶皮瓣 手部创面 显微外科手术 

分 类 号：R658.2[医药卫生—外科学]