腓动脉中低位穿支皮瓣带蒂转移修复足踝部皮肤软组织缺损的临床效果  

Clinical effects of middle and low peroneal artery perforator flap with pediele on repairing skin and soft tissue defects of ankle

作　　者：李海[1] 张程[1] 邓呈亮[1] 唐修俊[1] 聂开瑜[1] 魏在荣[1] 

机构地区：[1]贵州遵义医学院附属医院烧伤整形外科,563000

出　　处：《中华烧伤杂志》2017年第10期607-610,共4页Chinese Journal of Burns

基　　金：国家自然科学基金（81360295）;国家临床重点专科建设项目（国卫办医函[2013]544号）;贵州省优秀青年科技人才培养对象专项资金（黔科合人字[2013]12号）

摘　　要：目的探讨腓动脉中低位穿支皮瓣带蒂转移修复足踝部皮肤软组织缺损的临床效果。方法2012年4月～2015年12月，笔者单位收治20例足踝部皮肤软组织缺损伴肌腱、骨外露患者。皮肤软组织缺损面积5cm×4cm～23cm×10cm。患者人院后行创面清创及VSD等治疗。VSD治疗1周后，行皮瓣修复术。术前应用便携式多普勒血流探测仪探查腓动脉中低位穿支，根据创面情况设计皮瓣，术中切取皮瓣并保留各1条或2条腓动脉中、低位穿支。17例患者采用腓动脉中低位穿支皮瓣修复；余3例患者创面面积大，肌腱、骨外露创面采用腓动脉中低位穿支皮瓣修复，其余创面取同侧大腿中厚皮修复。皮瓣面积为6cm×5cm～25cm×12cm，供瓣区直接拉拢缝合或取同侧大腿中厚皮修复。结果术后除1例患者因静脉回流不畅致皮瓣远端部分表皮坏死，经换药、物理治疗后愈合外，余19例患者皮瓣及皮片存活良好。随访3～36个月，所有患者皮瓣外形较佳，供瓣区无明显瘢痕，患肢及踝关节功能正常。结论腓动脉中低位穿支皮瓣穿支较恒定，血供可靠，切取范围大，可修复足踝部皮肤软组织缺损。Objective To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle. Methods Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm ×4 cm to 23 cm × 10 cm. Patients were treated with debridement and vacuum sealing drainage （VSD） after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroheal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm× 5 cm to 25 cm × 12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side. Results After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well. Conclusions Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.

关 键 词：外科皮瓣 软组织损伤 足踝部 

分 类 号：R658.3[医药卫生—外科学]