游离腓动脉穿支皮瓣在足踝部软组织缺损中的临床应用  

Clinical application of free peroneal artery perforator flap in soft tissue defect of foot and ankle

作　　者：宋家林[1] 黄腾立 高涛 鲍丙波 林俊卿 钟万润 郑宪友[1] SONG Jialin;HUANG Tengli;GAO Tao;BAO Bingbo;LIN Junqing;ZHONG Wanrun;ZHENG Xianyou(Department of Orthopedics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital,Shanghai,200233,P.R.China)

机构地区：[1]上海交通大学附属第六人民医院骨科,上海200233

出　　处：《中国修复重建外科杂志》2021年第6期756-760,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨游离腓动脉穿支皮瓣修复足踝部软组织缺损疗效。方法回顾分析2019年3月—2020年3月采用游离腓动脉穿支皮瓣修复的18例足踝部软组织缺损患者临床资料。其中男11例,女7例;年龄21~58岁,平均45岁。缺损部位:踝部2例,后足4例,中足5例,前足7例。致伤原因:交通事故伤11例,机器伤4例,内固定术后感染坏死3例。受伤至皮瓣修复手术时间为12~48 d,平均24 d。创面缺损范围为3 cm×3 cm~15 cm×8 cm,皮瓣范围为4 cm×3 cm~16 cm×9 cm。记录患者皮瓣切取时间、手术时间、术中出血量及并发症发生情况等;随访期间观察皮瓣成活情况及患者满意度,采用美国矫形足踝协会(AOFAS)评分标准评价足部功能。结果皮瓣切取时间15~33 min,平均22 min;手术时间120~160 min,平均150 min;术中出血量90~180 mL,平均120 mL。术后发生血管危象3例,其中动脉危象2例,经血管探查、静脉移植桥接修复后成活;静脉危象1例,皮瓣部分坏死,经多次清创后植皮覆盖创面。余15例皮瓣完全成活。患者均获6个月随访,皮瓣外形良好,无明显臃肿;根据AOFAS评分标准评价足部功能,获优5例、良10例、中3例,优良率为83.3%。结论游离腓动脉穿支皮瓣易于切取,皮瓣形状及大小易于设计,不损伤肢体主干血管,肢体术后外观及功能可,可广泛应用于足踝部软组织缺损修复。Objective To investigate clinical application of the free peroneal artery perforator flap in soft tissue defect of foot and ankle. Methods The clinical data of 18 patients with soft tissue defects of foot and ankle who were repaired with free peroneal artery perforator flaps between March 2019 and March 2020 were retrospectively analyzed.Among them, there were 11 males and 7 females;the age ranged from 21 to 58 years, with an average age of 45 years. The defect was located in the ankle in 2 cases, in the hindfoot in 4 cases, in the midfoot in 5 cases, and in the forefoot in 7 cases.The causes of injury included 11 cases of traffic accident, 4 cases of machine injuries, 3 cases of infection and necrosis after internal fixation. The time from injury to flap repair was 12-48 days, with an average of 24 days. The range of wound was3 cm×3 cm to 15 cm×8 cm, and the range of skin flap was 4 cm×3 cm to 16 cm×9 cm. The flap harvesting time, operation time, intraoperative blood loss, and complications were recorded;the flap survival and patient satisfaction were observed during follow-up;and the American Orthopaedic Foot and Ankle Society(AOFAS) foot function score was used to evaluate the foot function. Results The flap harvesting time was 15-33 minutes(mean, 22 minutes);the operation time was 120-160 minutes(mean, 150 minutes);the intraoperative blood loss was 90-180 mL(mean, 120 mL). There were3 cases of vascular crisis after operation, including 2 cases of arterial crisis, which survived after vascular exploration and vein graft repair;1 case of venous crisis, partial necrosis of the skin flap, and skin grafting to cover the wound after repeated debridement. The remaining 15 skin flaps survived completely. All patients were followed up 6 months. The skin flaps were in good shape without obvious bloat. According to the AOFAS foot function score, 5 cases were excellent,10 cases were good, and 3 cases were fair. The excellent and good rate was 83.3%. Conclusion The free peroneal artery perforator flap is easy to harve

关 键 词：游离腓动脉穿支皮瓣 足踝部 软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]