吻合血管的腓肠内侧动脉穿支皮瓣修复足踝部软组织缺损的疗效观察  

Effect of vascular anastomosed medial sural artery perforator flap in the repair of lower extremity soft tissue defects

作　　者：陈传煌 张国雷 杨涛 李楚炎 陈明 姚海波 毛仁群 李文庆 Chen Chuanhuang;Zhang Guolei;Yang Tao;Li Chuyan;Chen Ming;Yao Haibo;Mao Renqun;Li Wenqing(Department of hand and foot surgery,Huazhong University of Science and Technology Union Shenzhen Hospital(Nanshan Hospital),Shenzhen 518052,China)

机构地区：[1]华中科技大学协和深圳医院(南山医院)手足显微外科,广东深圳518052

出　　处：《足踝外科电子杂志》2021年第3期34-37,共4页Electronic Journal of Foot and Ankle Surgery

基　　金：2018年广东省临床教学基地教学改革研究项目(2018JD076)。

摘　　要：目的探讨吻合血管的腓肠内侧动脉穿支皮瓣修复足踝部软组织缺损的疗效。方法选取华中科技大学协和深圳医院于2012年2月至2019年2月收治的9例足踝部软组织缺损患者作回顾性分析,所有病例均出现骨质和/或肌腱外露;跟腱损伤合并踝关节骨折2例,单纯性跟腱损伤2例,踝关节开放性骨折2例,足部开放性骨折3例;均行吻合血管的腓肠内侧动脉穿支皮瓣修复。结果患者皮瓣面积为(5.5±3.1)cm ×(9.3±2.5)cm,血管蒂长为(9.0±2.5)cm,平均随访(34±6)个月。术后皮瓣全部成活,皮瓣外形良好,除1例术后出现静脉危象,皮肤质地稍硬,其他8例皮瓣质地柔软。皮瓣供区直接缝合4例,需植皮修复5例(皮瓣供区植皮修复2例,术后边缘坏死,经换药后愈合,供区未发现明显的功能障碍;3例经吻合皮瓣皮神经修复,感觉恢复至S3—S3+)。结论应用吻合血管的腓肠内侧动脉穿支皮瓣修复足踝部软组织缺损,不损伤主干血管,血管蒂长穿支相对恒定,可同时吻合皮神经和重建皮瓣感觉,创面修复效果良好,为修复足踝部软组织缺损的一种实用术式。Objective To explore the effect of anastomosed medial sural artery perforator flap to repair soft tissue defects of ankle and foot.Methods 9 cases of soft tissue defects of the ankle and foot from February 2012 to February 2019 in Huazhong University of Science and Technology Union Shenzhen Hospital,were selected for retrospective analysis.All cases showed bone or (and) tendon exposure;Included 2 cases of achilles tendon injury and ankle fracture,2 cases of simple achilles tendon injury,2 cases of open ankle fractures,and 3 cases of open foot fractures;All were repaired with anastomosed medial sural artery perforator flaps.Results The area of the flap was (5.5±3.1) cm×(9.3±2.5) cm,and the vascular pedicle length was(9.0±2.5) cm.The average follow-up was (34±6) months.All the flaps survived and the flaps were in good shape.Except for 1 case with venous crises after surgery,the skin texture was slightly harder,the other 8 skin flaps were soft,the donor area was directly sutured in 4 cases,skin grafting was required in 5 cases,and the donor area had skin grafting in 2 cases with marginal necrosis,which healed after dressing change.No obvious dysfunction was found in the donor area.3 cases anastomosed the skin flap and the cutaneous nerve,and the sensation returned to S3—S3+.Conclusion Application of anastomosed medial sural artery perforator flap to repair soft tissue defects of ankle and foot.The vascular pedicle is long and the perforator is relatively constant.The skin nerve can be anastomosed at the same time to reconstruct the skin flap feeling.The wound repair effect is good,and it is a practical method to repair soft tissue defects of ankle and foot.

关 键 词：腓肠内侧动脉穿支皮瓣 足踝部 软组织缺损 修复 

分 类 号：R274.32[医药卫生—中医骨伤科学]