胫后动脉穿支蒂螺旋桨皮瓣修复小腿及足踝部皮肤软组织缺损  

Posterior tibial artery perforator pedicle propeller flaps for soft tissue coverage of the lower leg and foot defects

作　　者：俞芳[1] 唐举玉[1] 吴攀峰[1] 周征兵[1] 潘丁[1] 肖勇兵[1] 庞晓阳[1] 曾磊[1] 卿黎明[1] 刘睿[1] 

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华显微外科杂志》2017年第5期419-423,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金项目（81472104）

摘　　要：目的探讨胫后动脉穿支蒂螺旋桨皮瓣修复小腿及足踝部皮肤软组织缺损的临床疗效。方法2008年5月至2016年5月，采用胫后动脉穿支蒂螺旋桨皮瓣修复小腿、踝、足部皮肤软组织缺损30例，皮瓣切取面积8.0 cm×4.0 cm^24.0 cm×9.0 cm，其中5例携带筋膜瓣填塞腔隙，8例携带小腿深筋膜，6例携带大隐静脉与隐神经，皮瓣旋转160°~180°修复受区创面，供区创面直接缝合27例，植皮1例，接力皮瓣修复2例，术后回院随访记录皮瓣的外形、颜色、质地以及患者满意程度。结果本组有25例皮瓣完全成活，3例出现皮瓣远端部分表皮坏死，换药后创面愈合良好，1例皮瓣远端部分坏死，二期采用旋股外侧动脉降支穿支皮瓣游离移植修复，1例皮瓣完全坏死，换药治疗2.5个月后瘢痕愈合。术后随访4个月~4.5年（平均1.7年），皮瓣无臃肿、无溃疡、质地与周围皮肤接近，供区和受区外观恢复良好，患者对治疗结果满意。结论胫后动脉穿支蒂螺旋桨皮瓣具有供区损伤小、手术操作相对简单、术后并发症少、术后外形美观等优点，是修复小腿和足踝部皮肤软组织缺损的一种理想方法。ObjectiveTo investigate the clinical efficiency of posterior tibial artery perforator pedicle propeller flaps for soft tissue coverage of the lower leg and foot defects.MethodsFrom May, 2008 to May, 2016, 30 cases with soft tissue defects of the lower leg and foot were cured by using posterior tibial artery perforator pedicle propeller flaps. The size of flaps ranged from 8.0 cm×4.0 cm to 24.0 cm×9.0 cm. Fascia flap was harvested in 5 cases, 8 cases with deep fascia, and 6 cases with saphenous vein and saphenous nerve. The degree of flap rotation were from 160° to 180°. The donor sites were closed directly in 27 cases, and covered with skin grafting in 1 case, and with sequential flap in 2 cases. The shape, color, texture and satisfaction of the flaps were recorded during follow-up.ResultsTwenty-five flaps survived completely. The distal part of skin flap necrosis occurred in 3 cases and the wound healed well after dressing change. The distal part of flap necrosis occurred in 1 case, and free anterolateral thigh perforator flap was used to repair in the second phase. The complete necrosis of the flap occurred in 1 case, healing with scar after 2 months dressing treatment. All cases were followed-up from 4 months to 4.5 yeas （average 1.7 years） . All flaps were smooth with a satisfied appearance and high patient satisfaction.ConclusionPosterior tibial artery perforator pedicle propeller flap which has reliable blood supply, less donor-site morbidities, cosmetic shape, simple operation and less postoperative complications, is an ideal method for soft tissue coverage of the lower leg and foot defects.

关 键 词：胫后动脉 穿支皮瓣 螺旋桨 足踝部 小腿 

分 类 号：R658.3[医药卫生—外科学]