序贯式带蒂皮瓣修复足踝部皮肤缺损  

Sequential pedicled flaps for coverage of skin defects in foot and ankle

作　　者：康庆林[1] 贾亚超[1] 王亚洲[1] 徐佳[1] 陈红浩[1] 龚子凌 柴益民[1] 曾炳芳[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中华显微外科杂志》2015年第6期561-564,共4页Chinese Journal of Microsurgery

基　　金：国家自然科学基金面上项目（81272000）

摘　　要：目的 探讨序贯式带蒂皮瓣修复足踝部皮肤缺损的效果与手术技术. 方法 2006年1月-2013年12月,采用序贯式带蒂皮瓣修复足踝部皮肤缺损共12例,其中4例伴有跟腱损伤,修复缺损面积4.8cm×3.5 cm ～ 4.0 cm×10.0 cm.序贯式手术包括腓肠神经营养血管皮瓣移位修复足踝缺损,继发的供区再采用局部菱形带蒂皮瓣修复,不需要额外的植皮手术. 结果 移植的全部皮瓣共24个完全成活,手术时间平均约1h,随访6～16个月,移植皮瓣无臃肿、质地好,无片状的皮肤瘢痕,外形平整自然,无皱褶和色素沉着.踝关节伸屈功能均优于手术前,2例跟腱坏死者在皮瓣移植术后6～8个月再次接受肌腱移位手术,全部患者都取得了满意的效果. 结论 序贯式带蒂皮瓣修复足踝部软组织缺损是一种实用的手术方法,节省手术时间,避免了皮瓣供区植皮,修复效果好.Objective To evaluate the effect and surgical skills of sequential pedicled flaps for coverage of skin defects in foot and ankle.Methods From January, 2006 to December, 2013, sequential pedicled flaps were used to cover skin defects in foot and ankle in 12 cases, with Achilles tendon injuries in 4 cases.The size of defects ranged from 4.8 cm × 3.5 cm to 4.0 cm× 10.0 cm.This sequential procedure consisted of primary transfer of sural neurocutaneous vascular flap for covering foot and ankle defects, and closure of the secondary donor site using local rhomboic pedicled flap, without extra skin grafts.Results The mean time of operation was 1 hour.All 24 flaps survived completely.The follow-up time varied from 6 to 16 months.All flaps were flat with good contour and texture.No sheet skin scar, flap fold, or hyperpigmentation was recorded during follow-up.Both flexion and extension of the affected ankle joint improved significantly postoperatively.Achilles tendon necrosis occurred in 2 patients, which was managed by tendon transfer 6 to 8 months postoperatively.Satisfactory results were achieved in all patients.Conclusion Sequential pedicled flaps for covering skin defects in foot and ankle is a practical surgical procedure, characteristiced by shorter operation time, avoiding skin grafts, and satisfactory results.

关 键 词：腓肠神经营养血管皮瓣 穿支皮瓣 显微外科 软组织缺损 序贯式手术 

分 类 号：R658.3[医药卫生—外科学]