前踝上皮瓣穿支血管的临床分型及意义  

The clinical types and application of perforator branches of anterosuperior malleolus flap

作　　者：许亚军 陈政 周晓 包岳丰 张辉 杨凯 陈学明 

机构地区：[1]无锡市第九人民医院显微外科,江苏省无锡市214063

出　　处：《中华显微外科杂志》2016年第3期217-220,共4页Chinese Journal of Microsurgery

基　　金：无锡市科技局面上项目（CSE31N1432）;无锡市卫生局面上项目（ME201407）

摘　　要：目的介绍前踝上皮瓣穿支血管的临床分型，分析其临床意义。方法自2003年1月至2013年12月，对手部复杂软组织缺损，采用吻合血管的前踝上一足背皮瓣串联移植修复18例，其中前踝上一单块足背皮瓣12例，前踝上．足背分叶皮瓣4例，前踝上．足背三叶皮瓣2例：对足踝部软组织采用前踝上逆行岛状（骨）皮瓣修复22例，其中带胫前动脉主干的逆行前踝上逆行岛状皮瓣16例、足背．前踝上串联岛状皮瓣修复足背足底软组织缺损2例，不损伤胫前动脉主干的穿支蒂前踝上逆行岛状皮瓣2例，带胫骨下端的前踝上逆行岛状骨皮瓣2例。结果采用吻合血管的前踝上一足背皮瓣18例，术后17例皮瓣均顺利成活，1例串联皮瓣术后前踝皮瓣少部份坏死，后植皮成活，前踝上逆行岛状（骨）皮瓣22例，20例术后顺利成活，2例皮瓣术后出现静脉回流受限，至皮瓣边缘部份坏死，再行扩创植皮创面愈合。有30例经3～6个月随访，皮瓣外形满意，供区植皮愈合良好。对40例前踝上皮瓣的穿支血管根据术中进行临床分型，其中胫骨前肌内侧型20例，胫骨前肌、躅长伸肌间隙型16型，躅长伸肌、趾长伸肌间隙型4例。结论了解前踝上皮瓣穿支血管的临床分型，有助于手术中有序切取皮瓣，防止皮支损伤，提高手术的成功率。Objective To introduce the clinical types of perforator branches of anterosuperior malleolus flap and explore its application. Methods Anterosuperior malleolus flap coupling with dorsal pedal flap was used for repairing the soft tissue defect. Qf hands in 18 patients, in which anterosuperior malleolus flap-dorsal pedal single flap in 12 cases, anterosuperior malleolus flap-dorsal pedal bilobate flap in 4 cases, anterosuperior malleolus flap- dorsal pedal trilobate flap in 2 cases; Anterosuperior malleolus retrograde island （bone） flap was used in recovering pedal soft tissue in 22 patients, the flap pedicled from stem of anterior tibial artery in 16 cases, dorsal pedal flap- anterosuperior malleolus flap in 2 cases, the flap from perforate vessels without injuring the anterior main tibial artery in 2 cases, the bone flap combined with the distal of tibia in 2 cases. Results In the 18 cases of hands, 17 cases survived, and 1 case of flap mild necrosis at the distal site took a second-phase skin-grafting to repair. Twenty cases of anterosuperior malleolus retrograde island （bone） flap survived, and the other 2 cases needed see- ondary skin-grafting to repair the necrosis edge of flaps because of venous limited. After a follow-up from 3 to 6 months, 30 cases showed the satisfied postoperative outlook, with the good healing of the donor sites. Typing the 40 cases according to the location of perforator branches of the anterosuperior malleolus flap, 20 cases locate in the medial of anterior tibial muscle, 16 eases locate between the anterior tibial muscle and extensor hallueis longus, 4 cases locate between extensor hallucis longus and extensor digitorum longus. Conclusion Knowing the clinical types of the perforator branches of anterosuperior malleolus flap is not only helpful for the accurate processes of op- erations, preventing cutaneous branches, but also improving the success rate of surgery.

关 键 词：前踝上皮瓣 穿支皮瓣 穿支血管 临床分型 显微外科 

分 类 号：R658.2[医药卫生—外科学]