股深动脉第3穿支穿支皮瓣I期修复Pilon骨折术后软组织缺损  

Deep femoral artery third perforating flap for repair tissue defected of arrounding Pilon fracture in I stage

作　　者：黄雄杰[1] 谢松林[1] 刘昌雄[1] 王九松 刘一亮 夏晓丹[1] 黄新锋[1] 张辰昊[1] HUANG Xiongjie;XIE Songlin;LIU Changxiong;WANG Jiusong;LIU Yiliang;XIA Xiaodan;HUANG Xinfeng;ZHANG Chenghao(Department of Hand and Foot Surgery,Affiliated Nanhua Hospital,University of South China,Hengyang,Hunan Province 421002,China)

机构地区：[1]南华大学附属南华医院手足外科,湖南衡阳421002

出　　处：《中华显微外科杂志》2021年第3期287-291,共5页Chinese Journal of Microsurgery

基　　金：湖南省卫生计生委科研计划课题(A2017018)。

摘　　要：目的探讨股深动脉第3穿支穿支皮瓣I期修复Pilon骨折术后软组织缺损的临床疗效。方法2013年4月至2020年1月,收治15例Pilon骨折患者,其中Miller AO分类43-C18例,43-C24例和43-C33例,所有患者骨折周围均合并严重软组织挫伤,皮肤坏死,骨折复位后均合并软组织缺损、内固定外露及肌腱外露,I期应用游离股深动脉第3穿支穿支皮瓣修复踝关节周围软组织缺损,面积3.5 cm×15.5 cm-5.5 cm×12.5 cm,皮瓣血管与胫后或者胫前血管行端侧吻合。术后定期随访。结果15例皮瓣均顺利成活,其中1例血管卡压出现静脉危象,探查后皮瓣顺利成活,术后随访5-18个月,皮瓣质地良好,无色素沉着,膝关节周围肌肉力量无减退及粘连,供区仅留线形瘢痕,足踝部皮瓣稍臃肿,不影响穿鞋,皮瓣恢复保护性感觉。结论I期游离股深动脉第3穿支穿支皮瓣修复Pilon骨折术后中、小面积软组织缺损,可修复Pilon骨折术后踝关节周围软组织缺损,减低切开术后皮肤坏死和骨折感染,同时保护骨折周围血液供应,是一种有效的修复方法。Objective To investigate the clinical effect of free deep femoral artery third perforating flap repaired soft tissue loss after Pilon fracture surgery in I stage.Methods Fifteen patients were treated from April,2013 to January,2020.Miller AO classification:8 cases 43-C1,4 cases 43-C2 and 3 cases 43-C3.All cases were accompanied with severe soft tissue contusion and skin necrosis.After fracture reduction,soft tissue defects,internal fixation exposure and tendon exposure around the wound.Free deep femoral artery third perforating flap(3.5 cm×15.5 cm to 5.5 cm×12.5 cm)for the repair of soft tissue defects around ankle in the I stage,the blood vessels of the flap were end-to-side anastomosed with vessels of the posterior tibial or anterior tibial.Regular follow-up after surgery.Results One case of venous crisis occurred,other 14 cases survived,were followed-up from 5 to 18 months,the ankle joint function was good,did not affect the foot shoes,with excellent color and texture,the flap restored protective sensation,and leaving only linear scar,no muscle adhesion.Conclusion Free deep femoral artery third perforating flap repaired soft tissue loss of surgical incision after fracture operated than significantly reduce the postoperative fracture infection and protect the blood supply around the fracture.It is an effective method of repair.

关 键 词：穿支皮瓣 股深动脉第3穿支 PILON骨折 软组织缺损 显微外科技术 

分 类 号：R687.3[医药卫生—骨科学] R658.3[医药卫生—外科学]