胫后动脉和腓动脉穿支皮瓣修复足跟部创面18例  

Using the posterior tibial artery and peroneal artery perforator flaps to repair heel wounds: 18 cases report

作　　者：刘跃飞[1] 巨积辉[1] 周荣[1] 胡昌庆[1] 杨亮 陈鲁成 金乾衡 张广亮[1] Liu Yuefei;Ju Jihui;Zhou Rong;Hu Changqing;Yang Liang;Chen Lucheng;Jin Qianheng;Zhang Guangliang(Department of Foot and Ankle Surgery, Ruihua Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215104, China)

机构地区：[1]苏州大学附属瑞华医院足踝外科,江苏苏州215104

出　　处：《中华显微外科杂志》2019年第4期317-321,共5页Chinese Journal of Microsurgery

基　　金：江苏省青年医学人才项目(QNRC2016224).

摘　　要：目的探讨胫后动脉和腓动脉穿支皮瓣修复足跟部创面的临床疗效。方法自2011年1月至2018年5月,对18例外伤导致的足跟部软组织坏死缺损,分别采用胫后动脉和腓动脉穿支皮瓣转位修复,其中胫后动脉穿支皮瓣11例,腓动脉穿支皮瓣7例,皮瓣切取面积最大为11.0 cm×9.0 cm,最小为5.0 cm×3.0 cm,血管蒂长度10.0~16.0 cm。术后定期进行随访,观察骨折愈合时间、皮瓣外观与质地及踝关节功能。结果术后13例皮瓣一期成活,伤口愈合良好;2例胫后动脉穿支皮瓣远端部分坏死,术后1~2个月植皮修复;2例胫后动脉穿支皮瓣、1例腓动脉穿支皮瓣术后远端皮缘少许坏死瘢痕愈合。术后随访3~60个月,平均10个月。骨折愈合时间3~6个月,平均4个月。16例皮瓣质地柔软、外观满意,2例伤口瘢痕增生明显,供区无明显瘢痕挛缩。所有患者踝关节伸、屈功能无明显受限,采用美国足踝外科协会(AOFAS)踝与后足评分系统评分:优16例,良2例。结论依据足跟部创面特点采用胫后动脉穿支皮瓣、腓动脉穿支皮瓣转位修复,具有血管蒂长、临床疗效满意等优点,是一种简单而又实用的方法。Objective To investigate the clinical efficacy of using the posterior tibial artery and peroneal artery perforator flaps to repair the heel wounds. Methods From January, 2011 to May, 2018, heel soft tissue defect caused by trauma in 18 cases were treated by posterior tibial artery and peroneal artery perforator flaps respectively. The posterior tibial artery perforator flap was used in 11 cases, and the peroneal artery perforator flap was used in 7 cases. The area of flaps ranged from 5.0 cm×3.0 cm to 11.0 cm×9.0 cm. The length of the vascular pedicle was from 10.0 cm to 16.0 cm. After operation, the patients were followed-up regularly. The time of wound healing, appearance and texture of the flap, and function of ankle joint were observed. Results After the operation, 13 flaps survived uneventfully. The wound achieved primary healing. Partial necrosis occurred in the distal of posterior tibial artery perforator flap in 2 cases, and repaired by skin graft 1 or 2 months later. Marginal necrosis occurred in posterior tibial artery perforator flap in 2 cases and in peroneal artery perforator flap in 1 case. And scar healing occurred in these 3 cases finally. All the 18 patients were followed-up for 3 to 60 months, with an average of 10 months. Fracture healing time was from 3-6 months, with an average of 4 months. Flap was soft with satisfied appearance in 16 cases. Obvious scar formation occurred in 2 cases. There was no obvious scar contracture in donor sites. There was no obvious limitation of the flexion and extension function of the ankle joint in 18 cases. According to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, there was excellent in 16 cases, and good in 2 cases. Conclusion As for the characteristics of the heel wound, it is a simple and practical method to use leg perforator flap to repair. The flap is based on a long vascular pedicle. And the clinical effect is satisfied.

关 键 词：胫后动脉 腓动脉 穿支皮瓣 足跟 修复 

分 类 号：R658.3[医药卫生—外科学]