三维CT血管造影辅助血管定位设计游离腓动脉穿支皮瓣修复前足背软组织缺损  

Free peroneal artery perforator flap designed by vascular localization with three-dimensional CT angiography for repairing soft tissue defects of the dorsal forefoot

作　　者：刘春 杨学林 胡福兴 王强[2] Liu Chun;Yang Xuelin;Hu Fuxing;Wang Qiang(Department of General Surgery,Weifang Municipal Hospital,Weifang 2610OO,China;Department of Burn and Plastic Surgery,Hospital of 80th Group Army of PLA,Weifang 261021,China)

机构地区：[1]山东省潍坊市市立医院普通外科,261000 [2]中国人民解放军陆军第八十集团军医院烧伤整形科,潍坊261021

出　　处：《中华创伤杂志》2021年第9期786-792,共7页Chinese Journal of Trauma

摘　　要：目的探讨三维CT血管造影(3D-CTA)辅助血管定位设计游离腓动脉穿支皮瓣修复前足背软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2015年2月至2019年1月中国人民解放军陆军第八十集团军医院收治的17例前足背软组织缺损患者的临床资料,其中男11例,女6例;年龄16~65岁[(39.2±9.7)岁]。软组织缺损面积为3.0 cm×2.0 cm~10.0 cm×7.0 cm,皮瓣切取面积为3.5 cm×2.5 cm~10.5 cm×7.5 cm。术前行3D-CTA检查选取合适的穿支血管,根据检查结果及创面情况设计个性化皮瓣。Ⅰ期采用腓动脉穿支皮瓣移植修复10例,Ⅱ期扩创后采用腓动脉穿支皮瓣移植修复7例。比较术前3D-CTA检查所测量的穿支动脉的管径、穿支起始点至外踝尖垂直距离、穿支起始点至小腿外缘水平距离与术中实际测量值。术后观察皮瓣成活及血管危象情况。术前及术后6个月依照美国足踝外科协会(AOFAS)踝-后足评分评定患者足部功能。术后6个月依照皮瓣疗效满意度评分评定皮瓣修复效果,依照英国医学研究会(BMRC)等感觉功能评价标准评定皮瓣区域感觉功能。观察供区创面愈合及影响运动功能等情况。结果患者均获随访6~12个月[(9.6±2.3)个月]。术前3D-CTA检查所测量的穿支动脉的管径、穿支起始点至外踝尖垂直距离、穿支起始点至小腿外缘水平距离与术中实际测量值差异均无统计学意义(P>0.05)。皮瓣全部成活,无血管危象发生。术后6个月AOFAS踝-后足评分为(84.0±7.9)分,高于术前的(51.3±8.2)分(P<0.05),其中优12例,良5例。术后6个月皮瓣厚度与周围皮肤平齐,不影响穿鞋,皮瓣疗效满意度评分达(8.7±2.3)分,效果均满意;依照BMRC感觉功能评价标准,皮瓣感觉功能持续改善,10例患者达到S_(3)~S_(4)水平,两点辨别觉达(10.2±2.0)mm;7例患者达到S_(2)水平。供区切口均获得良好愈合,无明显瘢痕挛缩,供区肢体无关节运动功能受限。结论Objective To investigate the surgical method and clinical effect of the free peroneal artery perforator flap designed by vascular localization with three-dimensional CT angiography(3D-CTA)in repairing soft tissue defects of the dorsal forefoot.Methods A retrospective case series study was conducted to analyze the clinical data of 17 patients with soft tissue defects of the dorsal forefoot admitted to Hospital of the 80th Group Army of PLA from February 2015 to January 2019,including 11 males and 6 females,aged from 16 to 65 years[(39.2±9.7)years].The area of soft tissue defects ranged from 3.0 cmx2.0 cm to 10.0 cmx7.0 cm,and the size of skin flap was from 3.5 cmx2.5 cm to 10.5 cmX 7.5 cm.Preoperative 3D-CTA was performed to select the appropriate perforator vessels,and a personalized skin flap was designed according to the examination results and wound conditions.Of all,10 patients were repaired with the peroneal perforator flap at the first stage,and 7 patients grafted with peroneal perforator flap with wound expansion in the second stage.The perforator diameter,vertical distance from the starting point of the perforator to the tip of the lateral malleolus and horizontal distance from the starting point of the perforator to the outer edge of the lower leg were compared between preoperative 3D-CTA and actual intraoperative measurements.The survival of the flap and occurrence of the vascular crisis were observed after operation.The foot function was assessed with the American Orthopedic Foot and Ankle Society(AOFAS)ankle hindfoot score preoperatively and at postoperative 6 months.Six months after operation,effect of flap repair was evaluated by using flap satisfaction score and flap sensory function measured by the criteria established by British Medical Rresearch Council(BMRC).Incision healing and motor function of the donor area were detected.Results All patients were followed up for 6-12 months[(9.6±2.3)months].There was no statistically significant differences in perforator diameter,vertical distance from th

关 键 词：足损伤 软组织损伤 外科皮瓣 血管定位 

分 类 号：R658.3[医药卫生—外科学]