外踝上穿支岛状皮瓣在足底软组织缺损修复中的应用  

Application of lateral malleolus perforator island flap on repairing plantar soft tissue injury

作　　者：刘会军 夏既柏 郭路齐 曹云 梁德全 张正善 谢山洪 Liu Huijun;Xia Jibai;Guo Luqi;Cao Yun;Liang Dequan;Zhang Zhengshan;Xie Shanhong(Department of Hand and Foot Surgery,Beijing Chaoyang Emergency Rescue Center,Beijing 100023,China;Department of Hand and Foot Microsurgery,No. 464 Hospital of PLA,Tianjin 300381,China)

机构地区：[1]北京朝阳急诊抢救中心手足外科,100023 [2]解放军第四六四医院手足显微外科,天津300381

出　　处：《中华损伤与修复杂志（电子版）》2019年第3期213-217,共5页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

摘　　要：目的利用以外踝上穿支为血管蒂的穿支岛状皮瓣修复足底部软组织缺损,并探讨其手术方法及临床疗效。方法自2014年9月至2016年12月,笔者应用外踝上穿支岛状皮瓣修复足底软组织缺损10例(6例患者来自北京朝阳急诊抢救中心,4例患者来自解放军第四六四医院),男6例,女4例;年龄20.0~56.0岁,平均年龄34.4岁。致伤原因:机器伤6例,交通伤2例,重物砸伤2例。缺损面积2.5 cm×3.5 cm^10.0 cm×12.0 cm,采用面积为3.0 cm×4.0 cm^11.0 cm×14.0 cm外踝上穿支岛状皮瓣移植修复。供区创面宽度在3.0 cm以内者可以直接拉拢缝合,其余以全厚皮片植皮修复。通过电话、微信及门诊复查对10例患者进行随访。供区观察指标主要包括供区切口愈合情况及植皮成活情况;受区观察指标包括皮瓣外观、皮瓣感觉、负重行走情况。结果术后随访4.0~12.0个月,平均8.4个月。术后10例皮瓣顺利成活,9例切口一期愈合,1例皮瓣远端边缘部分坏死,经换药后愈合。供区切口愈合良好、皮片全部成活。皮瓣外形满意,质地柔软,无明显臃肿,半年后恢复保护性感觉(S2),无溃疡形成,穿鞋行走无疼痛、不适。结论外踝上穿支岛状皮瓣厚薄适中,血供可靠,不牺牲动脉主干,切取容易,可携带皮神经与受区皮神经吻合,恢复足底保护性感觉,是修复足底软组织缺损的有效方法之一。Objective To explore the method and clinical effect of repairing the soft tissue injury of the plantar using perforator island flaps pedicled with the perforator branch of the lateral malleolus.Methods From September 2014 to December 2016,10 patients(among them 6 patients from Beijing Chaoyang Emergency Rescue Center,and 4 patients from No.464 Hospital of PLA)including 6 males and 4 females with plantar soft tissue defect were repaired with the island flap of the superior perforator branch of the lateral malleolus.The average age was 34.4 years old(20.0-56.0 years old).Among them 6 patients were machine injury,2 patients were traffic accident injury and 2 patients were heavy objects injury.The defect area ranged from 2.5 cm×3.5 cm to 10.0 cm×12.0 cm,and the area of repaired island flap with perforator branch of the superior lateral malleolus ranged from 3.0 cm×4.0 cm to 11.0 cm×14.0 cm.The width of donor wound less than 3 cm can be directly sutured,and the rest were repaired with intermediate split thickness skin graft.Ten patients were followed up through telephone,Wechat and outpatient review.The healing of donor site incision and the survival of skin graft were observed for evaluating the recovery of donor site;the appearance,sensation of skin flap,and the weight-bearing walking were observed for evaluating the recovery of recipient site.Results All patients were followed up for 4.0-12.0 months after operation,with an average of 8.4 months.All the flap survived in the 10 patients.Nine patients wound healed in the first stage.Necrotic of distal edge of the flap happened in 1 patient and then healed after dressing change.The donor site healed well and all the skin grafts survived.The flap was satisfactory in appearance,soft in texture,without obvious swelling,and returned to protective sensation after half a year(S2),without ulcer formation,and without pain and discomfort when walking in shoes.Conclusions The superior perforator branch of lateral malleolus island flap is moderate in thickness,reliable in blo

关 键 词：外科皮瓣 足 踝 创伤和损伤 修复 

分 类 号：R658.3[医药卫生—外科学]