携带隐神经分支的胫后动脉穿支皮瓣感觉重建的临床应用  

Clinical application of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction

作　　者：孙鲁源 柴益民[2] 文根[2] 刘生和[2] 韩培[2] 汪春阳[2] 张长青[2] Sun Luyuan;Chai Yimin;Wen Gen;Liu Shenghe;Han Pei;Wang Chunyang;Zhang Changqing('.Department of Orthopedic Surgery,Third Affiliated Hospital of Soochow University,Changzhou,Jiangsu Province213003,China;Department of Orthopedic Surgery,Shanghai Sixth People's Hospital,Shanghai 200233,China)

机构地区：[1]苏州大学附属第三医院骨科,江苏常州213003 [2]上海市第六人民医院骨科,200233

出　　处：《中华显微外科杂志》2019年第2期125-127,共3页Chinese Journal of Microsurgery

摘　　要：目的探讨携带隐神经分支的胫后动脉穿支皮瓣感觉重建的手术设计及临床效果。方法2016年1月-2018年6月,采用携带隐神经分支的胫后动脉穿支皮瓣修复肢体软组织缺损患者9例,男7例,女2例,年龄31~62岁,创面位于手部5例,足底2例,踝部1例,足背部1例。软组织缺损面积为8.0cm×2.5cm^21.0cm×4.0cm。术后定期随访。结果本组皮瓣均完全成活,切取面积10.0cm×3.5cm^23.0cm×5.0cm。供区直接缝合5例,经皮肤牵张处理二期直接缝合4例。随访6~15个月,平均10个月。皮瓣无臃肿,供区隐神经支配区感觉正常。术后6个月,所有皮瓣S-W单丝检测均达到5.07,两点辨别觉在14~35mm。结论携带隐神经分支的胫后动脉穿支皮瓣具有不牺牲主干血管及隐神经主干、精准重建皮瓣感觉功能等优点,是软组织缺损感觉重建的一种良好选择。Objective To explore the operative technique and clinical results of posterior tibial artery perforator flap within saphenous nerve branch for sensory reconstruction.Methods From January,2016 to June,2018,9 patients suffered from soft tissue defect were treated by the posterior tibial artery perforator flap containing saphenous nerve branch.Seven patients were males and 2 were females,with age ranged from 31 to 62 years.Soft tissue defects located in hands in 5 patients,plantar in 2 patients,ankle in 1 patient and dorsal foot in 1 patient.The size of soft tissue defects ranged from 8.0 cm×2.5 cm to 21.0 cm×4.0 cm.The regular post-operative followed-up was performed.Results All flaps survived without complications.The size of flap ranged from 10.0 cm×3.5 cm-23.0 cm×5.0 cm.Donor sites were primarily closed in 5 patients and secondary closed in 4 patients.Followed-up ranged from 6 to 15 months with 10 months in average.The contour of flaps were satisfied and the sensory function of the donor sites were normal.At 6 months followed-up,SW test reached 5.07 in all flaps,and 2PD ranged from 14 to 35 mm.Conclusion The novel sensory flap can provide satisfied sensory outcome without sacrificing main artery and saphenous nerve,and is a good candidate for sensory reconstruction of soft tissue defects.

关 键 词：胫后动脉 穿支皮瓣 隐神经 感觉重建 软组织缺损 

分 类 号：R658.3[医药卫生—外科学]