跟外侧动脉穿支阶梯状V-Y推进皮瓣修复足跟部中小创面  

Stepladder V-Y advanced flaps based on the lateral calcaneal artery perforator for reconstruct the defects of lower-posterior heel

作　　者：吴泽勇 王绥江 黄海华 姚平[2] 史玉仓 李小芳 陈秀凤 Wu Zeyong;Wang Suijiang;Huang Haihua;Yao Ping;Shi Yucang;Li Xiaofang;Chen Xiufeng(Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China;Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, Hangzhou 310014, China;Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524001, China)

机构地区：[1]广东医科大学附属医院整形外科,湛江524001 [2]杭州整形医院整形外科,杭州310014 [3]广东医科大学附属医院病理科,湛江524001

出　　处：《中华整形外科杂志》2019年第2期148-153,共6页Chinese Journal of Plastic Surgery

基　　金：广东省湛江市科技计划项目课题(2017A01019).

摘　　要：目的探讨跟外侧动脉穿支阶梯状V-Y推进皮瓣的解剖学基础及其修复足跟部中、小创面的效果。方法解剖12例24侧广东医科大学人体解剖学教研室提供的下肢尸体标本,研究跟外侧动脉及腓动脉穿支的位置、数量及分布。在此基础上,应用跟外侧动脉和(或)腓动脉穿支阶梯状V-Y推进皮瓣修复足跟区域缺损患者22例,均为2009年6月至2016年6月于广东医科大学附属医院整形外科就诊患者,其中男18例,女4例,年龄5~69岁,平均27岁。结果尸体解剖发现腓动脉在外踝尖上(6.0±1.4)cm延续为跟外侧动脉,腓动脉和跟外侧动脉均发出穿支血管分布于跟腱区皮肤,在外踝尖水平线0~8.0cm范围内,24侧下肢尸体标本共有71条直径大于0.5mm的穿支血管,其中,腓动脉来源者为9%(7/71),跟外侧动脉来源者为91%(64/71)。临床应用22例,以跟外侧动脉和(或)腓动脉穿支为蒂,皮瓣面积3.5cm×9.0cm^5.0cm×10.0cm,除3例皮瓣尖端皮肤少量坏死,予换药后愈合,其余病例皮瓣均完全成活,伤口一期愈合。术后随防8~24个月,所有病例踝关节屈、伸活动及外观恢复良好,能负重行走,步态自然,皮瓣质地、感觉与周围皮肤相近,伤口无明显瘢痕及挛缩畸形,效果满意。结论跟腱区的皮肤血供主要来源于跟外侧动脉,部分由腓动脉供血。跟外侧动脉穿支阶梯状V-Y推进皮瓣能携带感觉神经、血供可靠,为足跟部中小创面修复的较好选择。Objective To explore the anatomy and clinical application of stepladder V-Y advanced flaps based on the lateral calcaneal artery perforator. Methods Twenty-four lower extremities from 12 adult cadavers were dissected to investigate the perforators emerging along the lateral edge of the achilles tendon, in terms of amount and distribution, relative to the tip of the lateral malleolus. Based on the anatomical findings, stepladder V-Y advanced flaps, based on the perforator(s) of the lateral calcaneal artery (LCA) or the peroneal artery (PA), were used for reconstruction of lower-posterior heel defects in 22 cases. Results Twenty-four lower extremities from 12 adult cadavers were successfully dissected. The peroneal artery continued to be the lateral calcaneal artery at the level of (6.0±1.4) cm above the tip of the lateral malleolus. Both of them have the perforators distributed to the skin in the achilles tendon area. In the space from the tip of the lateral malleolus to 8.0 cm and above, a total of 71 perforators with diameter larger than 0.5 mm were found in all extremities. Among them, 9%(7/71) were originated from peroneal artery, and 91%(64/71) were the lateral calcaneal artery. In the 22 cases of clinical application, the pedicle of flaps were used, based on the perforator of lateral calcaneal artery and (or) peroneal artery. The size of flaps ranged from 3.5 cm×9.0 cm to 5.0 cm×10.0 cm.There were 3 cases of skin necrosis at the tip of the flap, which were healed after dressing change. The other flaps had completely survived, and the wound healed in the first stage. Follow-up last for 8-24 months after operation. All patients had well recovery of ankle flexion, extension and appearance. They were able to weight-bearing walk, with natural gait. The texture and sensation of the flaps were similar to that of the surrounding skin. There were few obvious scar or contracture deformity. The functional recovery was satisfied. Conclusions The blood supply in the achilles tendon region is mainly from the lateral ca

关 键 词：外科皮瓣 软组织损伤 穿支皮瓣 跟外侧动脉 

分 类 号：R658.3[医药卫生—外科学]