改良螺旋桨穿支皮瓣在修复足跟周围软组织缺损中的应用  

Modified propeller perforator flap for repairing the soft tissue defects around the heel

作　　者：周洪翔[1] 陈亮[1] 李俊杰[1] 周洁浩[1] 宁涛[1] 付永彬[1] 周涛[1] 

机构地区：[1]安徽省阜阳市人民医院骨科,236000

出　　处：《中国矫形外科杂志》2017年第6期517-520,共4页Orthopedic Journal of China

摘　　要：[目的]观察应用改良螺旋桨穿支皮瓣治疗足跟周围软组织缺损的临床疗效。[方法]2012年7月~2016年6月本科收治足跟周围软组织缺损患者13例。男10例,女3例;年龄6~71岁,平均45.8岁。软组织缺损原因:外伤12例,慢性溃疡1例。软组织缺损部位:足跟偏外踝区3例,跟后区10例;应用改良胫后动脉穿支螺旋桨皮瓣修复5例,改良腓动脉穿支螺旋桨皮瓣修复8例。[结果]13例皮瓣全部成活,仅1例发生血管危像。12例患者分别进行3个月~3年的随访,1例因患者外出务工失访。随访结果:皮瓣血供丰富,质地柔软,外形良好,不臃肿,行走功能良好。足跟区皮瓣术后10个月恢复保护性感觉。[结论]改良螺旋桨皮瓣围绕穿支旋转180°大桨覆盖足跟周围中小面积软组织缺损,改良设计后的小桨可完全覆盖皮瓣供区缝合后遗留的创面而无需植皮。皮瓣的血供为皮瓣的穿支血管动静脉按比例的生理性循环,动脉供血充足,静脉回流充分,不易发生静脉循环危象,皮瓣成活率高,成活质量好。[Objective] To evaluate clinical outcomes of modified propeller perforator flap for repairing the soft tissue defects around the heel. [Methods] Thirteen patients with soft tissue defects around the heel were admitted into our hospital since July 2012 to June 2016 , including l 0 male and 3 female , with the average age of45.8 years old （range, 6-71years）. The soft tissue defects were caused by trauma in 12 cases and cronic ulcers in 1 case , located at lateral malleolus in 3 cases and heel in I0 cases. Modified posterior tibial artery perforator propeller flap was applied in 5 cases while modified peroneal artery perforator propeller flap was applied in others. [Results] The grafted flaps survived in all cases. Among them, venous crisis occurred in 1 cases. The patients were then followed up for 3 months to 3 years. Except for 1 lost-follow-up case, the shape and function in other cases were satisfactory. The flaps in the heel restored sensation 10 months postoperatively. [Conculsions ] Modified propeller perforator flap could rotate by 180 ° to repair soft tissue defects around the heel when the flap donor area can be stitched without skin grafting. The blood flow of flaps is perforating vessels, containing an artery and two accompanying veins, which coincides with physiological blood supply. The flap survives well as a resuh of adequate blood supply and venous return.

关 键 词：穿支皮瓣 足跟区 软组织缺损 

分 类 号：R658.3[医药卫生—外科学]