踝前穿支皮瓣修复足背皮肤软组织缺损  

Ankle anterior perforating flaps for reconstruction of soft tissue defects on dorsum of foot

作　　者：林涧[1] 王之江[1] 张天浩[1] 

机构地区：[1]上海交通大学医学院附属新华医院(崇明)骨、显微外科,202150

出　　处：《中华创伤杂志》2017年第10期873-877,共5页Chinese Journal of Trauma

基　　金：上海市科研计划（14411973200）;上海市崇明县科技攻关基金（CKY2015-05）

摘　　要：目的探讨踝前穿支皮瓣修复足背皮肤软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2009年1月～2017年3月收治的11例足背皮肤软组织缺损患者临床资料，其中男8例，女3例；年龄18～76岁，平均43．5岁。足背缺损创面4．0cm×3．5cm～15．0cm×6．0cm。根据踝前穿支皮瓣解剖学基础，按照足踝部创面皮肤缺损的大小、形状，在小腿下段前面设计并切取踝前穿支皮瓣转位修复足背创面，皮瓣最大面积为15．0cm×6．0cm，最小面积为4．0cm×3．2cm。根据皮瓣成活、感染控制、弹性色泽、外观形态、供区瘢痕、皮肤感觉、患者认可等情况，对患者前足创面修复的术后疗效进行综合评价。对皮瓣进行肿胀程度评级测定。结果10例皮瓣术后全部顺利成活，供、受区伤口均Ⅰ期愈合；1例皮瓣远端发生皮缘坏死，给予换药处理，供、受区伤口均完全愈合。术后随访3～24个月，平均12个月。皮瓣成活良好，形态满意，色泽、弹性与周围正常皮肤接近；供区瘢痕较小，踝及足功能满意。疗效满意9例，一般2例，无不满意。皮瓣肿胀评级，早期：Ⅱ度9例，Ⅲ度2例；后期：Ⅰ度11例。结论踝前穿支皮瓣修复足背部缺损创面方法简便、安全，穿支血管较为恒定，血供可靠，皮瓣成活率高，疗效满意，是修复足背皮肤软组织缺损较为理想的方法之一。Objective To explore the clinical effects of ankle anterior perforating flaps in reconstruction of the soft tissue defects on dorsum of foot. Methods A retrospective cases series study was done to analyze 11 patients with dorsal skin soft tissue defects： eight males and three females, with age ranging from 18-76 years （mean, 43.5 years）, treated from January 2009 to March 2017. The sizes of the soft tissues defects varied from 4.0 cm ×3.5 cm to 15.0 cm × 6.0 cm. According to the anatomical basis of ankle anterior perforating flaps, the sizes and shapes of the skin defects of the dorsal ankle, the flaps were designed and harvested in the anterior part of the lower leg to repair the dorsal skin soft tissue defects. The sizes of flaps ranged from 15.0 cm × 6.0 cm to 4.0 cm × 3.2 cm. The clinical effect was evaluated based on the flap survival, infection control, elasticity, color, appearance, scars of the donor sites, skin sensitivity and patient satisfaction. The extent of the flap swellings was also evaluated. Results All ten flaps survived after the surgery. Both the donor and recipient sites healed very well at I stage. One case had flap distal phalanx necrosis. After changing the ointments on time, both the donor and recipient sites survived completely. Duration of follow-up was 3-24 months （mean, 12 months）. The flaps survived very well with good shape, and the color and elasticity were very close to the normal skin nearby. The scars of the donor sites were small and the functions of ankle and foot were satisfactory. Satisfaction extents of treatment efficacy were good in nine patients and general in two, with no unsatisfaction. Flap swelling classification were nine cases of degree Ⅱ and two cases of degree Ⅲ in early stage while 11 cases of degree Ⅰ in later stage. Conclusions The ankle anterior perforating flap has constant perforating blood vessels ,reliable blood supply, high survival rate of flaps and hence is one of the simple, safe and optimal ways to repair the dorsal skin soft tis

关 键 词：足损伤 外科皮瓣 踝前穿支血管 

分 类 号：R658.3[医药卫生—外科学]