外踝前动脉降支顺行岛状皮瓣修复足踝部皮肤缺损  

Descending branch of anterior lateral malleolar artery based anterograde island flaps for reconstruction of foot and ankle defects

作　　者：董文伟 毛海蛟 刘振新 史增元 DONG Wen-wei;MAO Hai-jiao;LIU Zhen-xin(Department of Trauma and Orthopaedic,the Affiliated Hospital of Ningbo University,Ningbo 315000,Zhejiang,China)

机构地区：[1]宁波大学附属医院创伤骨科,浙江宁波315000

出　　处：《中国骨伤》2018年第7期661-665,共5页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨采用外踝前动脉降支顺行岛状皮瓣修复足踝部创面的手术方法及其临床应用效果。方法 :2015年6月至2017年1月,采用外踝前动脉降支顺行岛状皮瓣修复9例足踝部皮肤缺损的患者,其中男6例,女3例;年龄32～63岁。创面均位于足、踝部,并伴有骨、肌腱或血管神经外露,其中足部创面6例,踝部创面3例。皮肤缺损面积为1.5 cm×2.0 cm～6.0 cm×13.0 cm,切取皮瓣面积为2.0 cm×3.0 cm～7.0 cm×15.0 cm。皮瓣供区均取腹部全厚皮片植皮修复。术后观察岛状皮瓣外观、质地、供区情况,根据张浩等制定的疗效满意度评分方法进行满意度评价,并采用美国足踝外科学会(AOFAS)踝-后足功能评分进行功能评价。结果:9例患者术后皮瓣血液循环稳定,无一例发生回流障碍,均于术后2周Ⅰ期愈合。术后所有患者获得随访,时间2～18(8.0±2.3)个月。皮瓣全部Ⅰ期成活,蒂部平整,无臃肿及"猫耳"畸形,皮瓣质地柔软,外观满意,颜色与周围皮肤接近。供区游离植皮后创面平整,无明显瘢痕增生。9例患者满意度评分均为满意,AOFAS评分均为优。结论:采用外踝前动脉降支顺行岛状皮瓣具有不牺牲主干血管、皮瓣薄等优点,是修复足踝部创面的一种简单、有效的治疗方法。Objective：To explore surgical method and clinical effects of descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds. Methods：Nine patients with skin defects of foot and ankle repaired by descending branch of the anterior lateral malleolar artery based anterograde island flap were studied from June 2015 to January 2017,including 6 males and 3 females aged from 32 to 63 years old. The wound were located on foot and ankle and associated with exposure of bone,tendon,blood vessels or nerves. The surface of wound located on foot in 6 patients,and 3 patients in ankle joint. The area of defect ranged from 1.5 cm ×2.0 cm to 6.0 cm ×13.0 cm,and the area of flap ranged from 2.0 cm×3.0 cm to 7.0 cm×15.0 cm. The donor site was skin grafted with split-thickness skin from abdomen. Appearance,texture,condition of donor site of island flaps after operation were observed,satisfied degree of clinical effects were evaluated by ZHANG Hao＇s evaluation,and AOFAS score were used to evaluate function. Results：Circulations of flaps in 9 cases were stable without blockage,and healed well at 2 weeks after operation. All patients were followed up from 2 to 18 months with an average of（8.0±2.3） months. All flap were survived at stage Ⅰ,pedicles looked smooth and tidy,no cat ear formed,the texture of flap was soft with satisfied appearance,the color was near to surrounding skin. The surface of wound were tidy after skin graft of donor sites without scar hypertrophy. Nine patients got satisfied results according to ZHANG Hao＇s evaluation,and AOFAS score was excellent. Conclusion：Descending branch of the anterior lateral malleolar artery based anterograde island flap for repairing foot and ankle wounds,which has advantages of protect main vessel,thin flap,is a simple and effective method.

关 键 词：外科皮瓣 足踝 创伤和修复 

分 类 号：R658.3[医药卫生—外科学]