三维CT血管造影辅助设计足内侧隐神经营养血管皮瓣修复足远端软组织缺损  

The reverse saphenous nerve neurocutaneous flaps for reparing skin defects of forefoot with the help of three-dimensional computerized tomography angiography

作　　者：窦金兰[1] 田振欣 郑珊珊 尚永 徐岳杰 周志航 郑广程 宋克伟 陈飞飞 Dou Jinlan;Tian Zhenxin;Zheng Shanshan;Shang Yong;Xu Yuejie;Zhou Zhihang;Zheng Guangcheng;Song Kewei;Chen Feifei(Department of Hand and Foot Surgery,the Yidu Central Hospital of Weifang,Weifang 262500,China;Department of Orthopaedics,the Qingzhou Hospital of Traditional Chinese Medicine,Qingzhou 262500,China;Department of Traumatic Osteopathic,Dezhou People’s Hospital,Dezhou 253045,China)

机构地区：[1]山东省潍坊市益都中心医院手足外科,262500 [2]山东省青州市中医院骨科,262500 [3]山东省德州市人民医院骨科,253045

出　　处：《中华整形外科杂志》2020年第2期175-179,共5页Chinese Journal of Plastic Surgery

基　　金：潍坊市益都中心医院伦理委员会批准(20130913107)o.

摘　　要：目的探讨三维CT血管造影技术(three-dimensional computerized tomography angiography,3D-CTA)辅助设计足内侧隐神经营养血管皮瓣,逆行修复足远端皮肤软组织缺损的临床效果。方法2013年11月至2018年2月,潍坊市益都中心医院收治19例足远端缺损患者,男12例,女7例,年龄16~45岁,平均29.6岁。术前行同侧足3D-CTA检查,了解供区血管情况,明确FDA2趾底内侧动脉浅支的位置、走行、长度、与周围邻近组织关系,设计足内侧隐神经营养血管皮瓣逆行修复足远端皮肤软组织缺损创面。随访时根据Sanders等的Maryland足功能评分标准评定足、踝部功能,根据Swanson等的周围神经损伤临床效果评价标准对感觉恢复情况进行评估。结果术前采用3D-CTA均能检测到FDA2趾底内侧动脉浅支,术中所见穿支血管情况与检查图像结果显示基本一致。术后皮瓣全部成活,所有病例均得到随访,时间为6~12个月,平均8个月,皮瓣外观较好,血运可靠,足、踝部功能基本正常,穿鞋及负重无明显影响。足、踝部功能恢复达优者8例,良10例,中1例。足远端皮肤感觉恢复达S45例,S310例,S24例;感觉恢复范围达R43例,R39例,R27例。结论术前行3D-CTA检查,可以明确供区FDA2趾底内侧动脉浅支解剖情况,指导设计足内侧隐神经营养血管皮瓣逆行修复足远端皮肤软组织缺损,血供可靠,创伤小,效果满意。Objective To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot with the help of the three dimensional computerized tomography angiography(3DCTA).Methods From November 2013 to February 2018,19 patients with anterior foot defects were treated in the Yidu Central Hospital of Weifang.There were 12 males and 7 females.The patients ranged from 16 to 45 years old,with an average age of 29.6 years.Preoperative 3D-CTA examination of the ipsilateral foot was performed to find out the blood vessels in the donor site,to determine the location,course,length of the superficial branch of the medial plantar toe artery and its relationship with the surrounding tissues,and to design the medial saphenous nerve nutrient vessel skin flap for retrograde repair of the skin and soft tissue defect at the front of the fool.Sensitive recovery were evaluated according to Swanson evaluation of clinical effect of peripheral nervous impairment.Results Preoperative three dimensional CT angiography showed that the superficial branches of the medial plantar toe artery were detected,and the perforating vessels during the operation were basically consistent according to the result of the examination.The 19 cases of forefeet skin detects were successfully reconstructed with the reverse saphenous nerve neurocutaneous flaps.All patients were followed up with the mean of 8 months.All flaps survived totally without diabrosis and swelling.The walking and weight-bearing were normal and the blood supply of foot were good.The functional recovery of foot and ankle was excellent in 8 cases,good in 10 cases and middle in 1 case.The sensory recovery of the forefoot:S45 feet,S310 feet,S24 feet;R43 feet,R39 feet,R27 feet.Conclusions Preoperative 3D-CTA examination can confirm the anatomy of the superficial branch of the medial toe base artery in the donor site and guide the design of the medial saphenous nerve nutrient vessel flap for retrograde repair of skin and soft tissue defects of the distal foot.The blood s

关 键 词：三维重建 计算机体层摄影血管造影 外科皮瓣 隐神经营养血管皮瓣 足 缺损 

分 类 号：R65[医药卫生—外科学]