不同形式足内侧皮瓣修复前足软组织缺损  

Application of medialis pedis flap with various forms in the repair of soft tissue defects at the forefoot

作　　者：裴少琨 李卫海 崔留超 徐文龙 PEI Shao-kun;LI Wei-hai;CUI Liu-chao;XU Wen-long(Department of Orthopedics,The Fourth People's Hospital of Shanxi Province,Xi′an 710043,China)

机构地区：[1]陕西省第四人民医院骨科,陕西西安710043 [2]淮阳楚氏骨科医院显微外科,河南淮阳466700 [3]重庆长城医院创伤修复显微外科,重庆400000

出　　处：《中国美容整形外科杂志》2019年第11期651-654,共4页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的探讨不同形式足内侧皮瓣的血供来源及修复前足软组织缺损的临床效果。方法对12侧成人足标本的动脉内灌注红色乳胶进行解剖,观察拇趾胫侧底动脉与足内侧皮神经营养血管以及第1跖底动脉、足底内侧动脉浅支、内踝前动脉、跗内侧动脉间吻合关系。根据解剖的实际情况,对临床12例患者设计足内侧皮瓣,分别切取穿支螺旋桨皮瓣(5例)、皮神经营养血管筋膜蒂皮瓣(4例)、穿支+皮神经营养血管筋膜蒂皮瓣(3例)修复前足软组织缺损。结果解剖显示拇趾胫侧底动脉与足底内侧动脉浅支、内踝前动脉、跗内侧动脉间的血管吻合以及与足内侧皮神经营养血管的吻合,共同构成足内侧皮瓣的血运基础。所有患者的皮瓣及植皮区均成活,供区创缘一期愈合。随访6~24个月,皮瓣外形及功能较满意,皮瓣色泽与周围皮肤一致,无溃疡发生,均恢复保护性感觉;其穿鞋行走及负重等功能均未受到影响。结论根据足内侧穿支血管的实际情况,灵活设计并切取不同形式的足内侧皮瓣修复足前部皮肤缺损,血供可靠,操作简单,供区损伤较小,是修复前足软组织缺损较理想的皮瓣供区。Objective To explore the blood supply of medialis pedis flap with various forms and clinical efficacy of medialis pedis flap in the repair of soft tissue defects at the forefoot.Methods Red latex was perfused into artery of 12 formaldehyde-fixed cadaver feet for dissection.Vascular anastomotic network among medial plantar artery of the hallux,medial dorsal cutaneous nerve nutrient vessels,first plantar metatarsal artery,superficial branch of medial plantar artery,anterior medial malleolar artery and medial tarsal artery was observed.According to actual conditions of anatomy,medialis pedis flap with various forms was designed for 12 patients with soft tissue defects at forefoot region.Propeller medialis pedis perforator flap of 5 cases,fasciocutaneous flap with neurocutaneous nerve nutrient vessels of 4 cases and medialis pedis flaps pedicled with perforator plus cutaneous nerve nutrient vessel of 3 cases were cut for repair of soft tissue defects at the forefoot.Results The vascular anastomotic network of medial plantar artery of the hallux,medial dorsal cutaneous nerve nutrient vessels,first plantar metatarsal artery,superficial branch ofmedial plantar artery,anterior medial malleolar artery and medial tarsal artery forms the anatomical basis of medial pedis flap.All flaps and skin grafts survived,and all donor sites healed by first intention.The follow-up ranged from 6 to 24 months,the appearance and function of flaps are satisfactory.The color of flaps was consistent with that of the surrounding skin.No ulcer occurred.All flaps regained protective sensation,and functions of wearing shoes and weight bearing were not affected.Conclusion The defects of forefoot can be repaired by medialis pedis flaps with various forms according to the actual situation of medialis pedis perforators.The blood supply of flap was reliable,operative procedure was simplified and donor site morbidity was minimized.The medialis pedis flap was an ideal choice in the repair of soft tissue defects at the forefoot.

关 键 词：足内侧皮瓣 前足缺损 螺旋桨皮瓣 岛状皮瓣 游离移植 

分 类 号：R68[医药卫生—骨科学]