以前支为蒂的逆行跗外侧动脉穿支皮瓣修复前足软组织缺损  

Repairing soft tissue defect in forefoot by a retrograded lateral tarsal artery perforator flap pedicled with anterior branch

作　　者：杨涛 张广超 周明武 胡智玉 李士民 幸超峰 YANG Tao;ZHANG Guangchao;ZHOU Mingwu;HU Zhiyu;LI Shimin;XING Chaofeng(Department of Trauma and Microsurgery,988 Hospital of Joint Logistic Support Force,P.L.A Zhengzhou 450042,China)

机构地区：[1]中国人民解放军联勤保障部队第九八八医院创伤显微外科,郑州450042

出　　处：《中华显微外科杂志》2020年第1期15-19,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨以前支为蒂的逆行跗外侧动脉穿支皮瓣修复前足软组织缺损的手术方法及临床疗效。方法2015年3月至2018年10月,采用以前支为蒂逆行跗外侧动脉穿支皮瓣修复前足软组织缺损9例,其中急诊修复1例,二期修复8例,创面均位于前足,缺损面积3.0 cm×2.0 cm^5.0 cm×4.0 cm,皮瓣切取面积为3.5 cm×3.0 cm^6.0 cm×4.5 cm。皮瓣供区采用全厚皮片植皮修复。术后通过门诊、微信、电话定期随访。结果8例皮瓣顺利成活,伤口I期愈合;1例皮瓣术后2 d发生静脉危象,经蒂部拆线处理,仅远端皮缘发生坏死,换药处理瘢痕愈合;皮瓣供区植皮均成活良好。术后均获得随访3~18个月,皮瓣质地良好,外观无明显臃肿,感觉部分恢复。其中8例末次随访采用美国足踝外科协会(AOFAS)中足评分标准评价,优5例,良2例,差1例,优良率87.5%。结论采用以前支为蒂的逆行跗外侧动脉穿支皮瓣修复前足软组织缺损,不损伤足背动脉主干,皮瓣血供可靠,操作相对简单,是修复前足软组织缺损的有效方法之一。Objective To investigate the surgical method and clinical effect of repairing the forefoot soft tissue defect by the retrograded lateral tarsal artery perforator flap pedicled with the anterior branch.Methods From March, 2015 to October, 2018, 9 patients with soft tissue defects in forefoot were repaired by the retrograded lateral tarsal artery perforator flap pedicled with anterior branch. One patient received an emergency repair and 8 received secondary repair. The wounds were all located in the forefoot. Area of defects were 3.0 cm×2.0 cm-5.0 cm×4.0 cm;flap areas were 3.5 cm×3.0 cm-6.0 cm×4.5 cm. The donor sites of flap were repaired with full thickness skin graft. All patients received postoperative followed-up through the visits of outpatient clinics, WeChat or telephone reviews.Results Eight flaps survived successfully and the wounds healed by first intention;One flap had venous crisis 2 days after surgery and after having removed stitches of the pedicle of flap, only distal skin necrosis occurred. And healed after changing treatment. All the skin graft in donor sites of flaps survived well. All patients were entered 3 to 18 months postoperative follow-up. The shape of flaps had good textures and were not bloated. The sensation of flaps partially recovered. In the last followed-up, 8 flaps were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) middle foot scoring standard. The results were excellent in 5 cases, good in 2 cases and poor in 1 case, with the good and excellent rate of 87.5%.Conclusion The retrograde lateral tarsal artery perforator flap pedicled with the anterior branch is one of the effective methods to repair the soft tissue defect in forefoot without damaging the main trunk of dorsal pedal artery. It features a reliable blood supply to the flap and a relatively simple surgical procedure.

关 键 词：跗外侧动脉穿支皮瓣 前支 前足 修复 

分 类 号：R65[医药卫生—外科学]