胫后动脉穿支螺旋桨皮瓣修复内踝软组织缺损  

Repair of soft tissue defects of medial malleolus with propeller flap with perforating branch of posterior tibial artery

作　　者：赵德华 孙郁文 李跃红 周坚龙 陈林海 Zhao Dehua;Sun Yuwen;Li Yuehong;Zhou Jianlong;Chen Linhai(Department of Orthopedics,Ningbo Ninth Hospital,Ningbo 315000,China;Department of Repair and Reconstructive Surgery,Ningbo First Hospital,Ningbo 315000,China)

机构地区：[1]宁波市第九医院骨一科,315000 [2]宁波市第一医院修复重建外科,315000

出　　处：《中华整形外科杂志》2020年第9期1000-1004,共5页Chinese Journal of Plastic Surgery

摘　　要：目的探讨胫后动脉穿支螺旋桨皮瓣修复内踝软组织损伤的临床效果。方法2016年6月至2019年3月宁波市第九医院共收治5例男性踝部外伤患者,年龄30~64岁,平均45岁,右侧3例,左侧2例。病因:交通伤2例、压砸伤3例。其中4例合并骨折,1例合并钢板和骨外露,2例合并局部感染,1例皮肤撕脱伤。术前软组织缺损面积:2.0 cm×3.0 cm^4.0 cm×6.0 cm。清创后设计胫后动脉穿支螺旋桨皮瓣修复创面,术中于深筋膜浅层长屈肌和趾长屈肌间寻找目标穿支,充分显露穿支蒂部,保留蒂部长度≥2 cm并携带少量筋膜组织。在深筋膜浅层完全切取皮瓣后旋转皮瓣拟覆盖创面,确认皮瓣血供良好后与创面疏松缝合,供区直接缝合或植皮覆盖。术后均常规补液、抗感染、抗痉挛、抗血栓形成治疗,踝关节中立位抬高并以石膏制动,监测皮瓣的温度、颜色、张力和返流情况,并逐步进行康复锻炼。观察患者术后修复效果。结果5例皮瓣均成活,穿支点距内踝5.5~8.5 cm,切取皮瓣面积:4.0 cm×6.5 cm^4.0 cm×10.0 cm,供区除1例植皮外其余均直接缝合。术后随访3~16个月,平均12个月,无皮瓣相关并发症发生,无明显瘢痕增生,与局部皮肤性状相近,踝关节活动可,皮瓣恢复保护性感觉。结论胫后动脉穿支螺旋桨皮瓣具有操作简便,软组织性状相近,血供稳定可靠,供受区损伤小,并发症少等特点,是修复内踝软组织缺损的理想方法之一。Objective To investigate the clinical effect of posterior tibial artery perforator propeller flap in repairing soft tissue injury of medial malleolus.Methods From June 2016 to March 2019,five male patients with ankle trauma were treated in Ningbo Ninth Hospital,aged 30-64 years(average 45 years).There were 3 cases of right and 2 cases of left.Causes:traffic injury in 2 cases,crush injury in 3 cases.There were 4 cases with fracture,1 case with plate and bone exposure,2 cases with local infection and 1 case with skin avulsion.Preoperative soft tissue defect area:2.0 cm×3.0 cm-4.0 cm×6.0 cm.After debridement,the posterior tibial artery perforator propeller flap was designed to repair the wound.During the operation,the target perforator was searched between the deep fascia superficial flexor longus and digitorum flexor longus,and the perforator pedicle was fully exposed carrying a small amount of fascial tissue and the length of the pedicle≥2 cm.After the skin flap was completely cut from the superficial layer of the deep fascia,the skin flap was rotated to cover the wound.After confirmation of good blood supply of the skin flap,the wound was loosely sutured,and the donor site was directly sutured or covered with skin grafts.Routine fluid rehydration,anti-infection,anti-spasm,and anti-thrombosis treatments were performed postoperatively.The ankle joint was raised in a neutral position and immobilized with plaster.The temperature,color,tension and reflux of the skin flap were monitored,and rehabilitation exercises were gradually carried out.The patient’s postoperative repair effect was observed.Results All the flaps survived.The distance between the perforator and the medial malleolus was about 5.5-8.5 cm.The area of the flap was 4.0 cm×6.5 cm-4.0 cm×10.0 cm.The donor sites were sutured directly except one case.No flap related complications occurred during the follow-up period of 3-16 months(average of 12 months).No obvious scar hyperplasia was observed in flaps,which was similar to the adjacent skin character

关 键 词：胫动脉 穿支皮瓣 软组织损伤 螺旋桨 

分 类 号：R658.3[医药卫生—外科学]