第1跖背逆行岛状皮瓣切取方法的改进及在足趾缺损创面修复中的应用  

Improvement of first metatarsal dorsal island flap and its application in reconstruction of toes soft-tissue defects

作　　者：陈玉兵[1] 王丽丽 CHEN Yubing, WANG Lili(Department of Hand and Foot Surgery, Xuecheng People＇s Hospital, Zaozhuang, Shandong, 277000, Chin)

机构地区：[1]枣庄市薛城区人民医院手足外科,山东枣庄277000 [2]枣庄矿业集团中心医院,山东枣庄277899

出　　处：《实用手外科杂志》2018年第1期64-67,共4页Journal of Practical Hand Surgery

摘　　要：目的探讨改进的第1跖背逆行岛状皮瓣修复多种足趾缺损创面的临床疗效。方法 2004年12月-2015年6月对第1跖背逆行岛状皮瓣的切取方法进行改进,在皮瓣切取时不考虑第1跖背动脉的解剖类型,不苛求将第1跖背动脉完全包含在皮瓣内,皮瓣位于第1骨间背侧肌肌膜上的部分及蒂部均在骨间背侧肌肌膜下紧靠肌膜进行切取,蒂部以腓深神经、第1跖背静脉为中心保留宽2.0 cm的筋膜组织并用改进后的第1跖背逆行岛状皮瓣修复各种足趾缺损创面46例。结果 46例皮瓣全部成活,其中有6例皮瓣远端出现水疱、浅表坏死情况,经换药后愈合。术后随访6个月~3年,皮瓣外形美观,患足功能满意。结论无论第1跖背动脉为何种类型改进的第1跖背逆行岛状皮瓣,均可顺利切取,血运可靠,切取层面恒定,手术操作简单,可用于多种足趾缺损创面的修复。Objective To report the clinical results of repairing various soft-tissue defects located at the toe with a modified first plantar retrograde island flap. Methods The operative method of the first plantar retrograde island flap was improved as follows： the anatomical type of the first plantar dorsal artery was not taken into account when The flap was cutted, it was not necessary to contain the first plantar dorsal artery completely in the flap, the flap and pedicle located on the first dorsal interosseous muscle was cutted under myolemma of the dorsal interosseous muscle, the width of pedicle fascia was reserved 2.0 cm and the deep peroneal nerve and the first metatarsal dorsal vein were used as the center of the pedicle fascia. From December 2004 to June 2015, the modified first plantar retrograde island flap had been used to treat the toes soft-tissue defects in forty-six patients. The size of flaps ranged from 2.5 cmX3.0 cm to 4.5 crux6.0 cm. Results The transferred flaps survived completely In forty patients and in six flaps there were superficial marginal necrosis, healed after change dressings. Followed-up after 6 months to 3 years, the contour of the flap was satisfactory. All the patients had no difficulty in wearing shoes. All patients returned to their normal walking and running activities. No donor-site morbidity was encountered. Conclusion No matter what type of the first dorsal metatarsal artery, the modified flaps is a viable alternative for reconstruction of a variety of toes soft-tissue defects, with reliable blood supply, constant cutting level, and simple operative procedure.

关 键 词：第1跖背动脉 外科皮瓣 足趾 皮肤软组织缺损 

分 类 号：R658.3[医药卫生—外科学]