足底内侧穿支皮瓣修复足跟部创面的临床应用  

Clinical application medial plantar perforator flap in the repair of achilles tendon injury combined with soft tissue defects

作　　者：朱伟 于志刚 李卫海 吴亚妮 杨利学 谭龙旺 孙智平 仇永锋 ZHU Wei;YU Zhi-gang;LI Wei-hai;WU Ya-ni;YANG Li-xue;TAN Long-wang;SUN Zhi-ping;QIU Yong-feng(Department of Spine Surgery,Hospital Affiliated to Shanxi University of Chinese Medicine,Xianyang 712000,China)

机构地区：[1]陕西中医药大学附属医院脊柱骨科,陕西咸阳712000 [2]凉山骨科医院骨创伤科,四川西昌615000 [3]河南淮阳楚氏骨科医院显微外科,河南周口466700 [4]陕西中医药大学附属医院骨创伤二科,陕西咸阳712000

出　　处：《中国美容整形外科杂志》2019年第11期655-657,I0011,共4页Chinese Journal of Aesthetic and Plastic Surgery

基　　金：陕西省中医药管理局科技计划项目（JCPT019）;陕西省教育厅科技计划项目（18JK0210）

摘　　要：目的探讨带蒂足底内侧穿支皮瓣应用于跟腱损伤合并皮肤软组织缺损修复的效果。方法对跟腱损伤合并表面皮肤软组织复合性缺损患者18例,缺损面积为4.0cm×2.0cm^10.0cm×5.0cm,均采用带蒂足底内侧穿支皮瓣转移修复跟腱表面皮肤软组织缺损。其中12例跟腱断裂未合并明显缺损,采用传统的修复方法直接缝合固定;6例合并跟腱缺损(长度为3.0~8.0cm),采用腓骨短肌肌腱转位(4例)和腓骨短肌肌腱转位合并腓肠肌肌腱翻转加固重建(2例)。评估缺损情况、手术成功率、并发症情况以及随访外观功能情况。结果所有患者获随访10~42个月(平均18.5个月),供、受区创面均一期愈合;单足提踵试验呈阴性,无跟腱再次断裂;皮瓣无溃破、感染等并发症。按Thermann功能评定标准:优8例,良6例;优良率为77.8%。结论采用带蒂足底内侧穿支皮瓣转移修复跟腱损伤合并周围皮肤软组织缺损,其皮瓣质地较好,厚度适中,且耐磨耐压,是修复跟腱部皮肤缺损较理想的方法之一。Objective To explore the efficacy of medial plantar perforator flap in the repair of Achilles tendon injury combined with soft tissue defects.Methods Eighteen patients with Achilles tendon injury combined with soft tissue defects were repaired by pedicled medial plantar perforator flap.The area of defects ranging from 4.0 cm×2.0 cm to 10.0 cm×5.0 cm.Rupture of Achilles tendon without obvious defects occurred in 12 patients.Conventional restorative procedure was used for direct suture and fixation.Achilles tendon rupture combined with defects with the length from 3.0 to 8.0 cm occurred in 6 patients.Transposition of peroneus brevis tendon was performed in 4 patients.Transposition of peroneus brevis tendon combined with reconstruction of gastrocnemius tendon flap turnover reinforcement was performed in 2 patients.The condition of defects,success rate of operation,complications,aesthetic and functional outcome were elevated.Results All patients were followed-up from 10 to 42 months,with an average of 18.5 months.The wounds in both donor and recipient sites healed by first intention.A single-heel rise test was negative.No complications such as re-rupture of Achilles tendon,necrosis or infection of flaps occurred.According to Thermann functional assessment standard,8 patients were excellent and 6 were good,the excellent and good rate was 77.8%.Conclusion The application of pedicled medial plantar perforator flap was one of the ideal methods in the repair of Achilles tendon injury combined with soft tissue defects.This flap had good texture,moderate thickness and wear resistance and pressure resistance.

关 键 词：皮瓣移植 跟腱缺损 显微外科 足底内侧穿支皮瓣 

分 类 号：R68[医药卫生—骨科学]