腓肠内侧动脉和胫后动脉穿支螺旋桨皮瓣接力修复足踝部皮肤软组织缺损  

Medial sural artery perforator propeller flap relay posterior tibial artery perforator propeller flap for soft tissue coverage of the foot and ankle defects

作　　者：郭佳 刘勇 韩宁 Guo Jia;Liu Yong;Han Ning(Department of Hand and Foot Orthopedics Surgery,Weifang People’s Hospital,Weifang 261000,China;Department of Orthopedics,the 80th Group Military Hospital,Weifang 261000,China)

机构地区：[1]潍坊市人民医院手足骨外科,261000 [2]陆军第80集团军医院骨科,潍坊261000

出　　处：《中华整形外科杂志》2021年第10期1158-1162,共5页Chinese Journal of Plastic Surgery

基　　金：中国人民解放军后勤科研面上项目(CLJ18J020)。

摘　　要：目的探讨应用腓肠内侧动脉穿支螺旋桨皮瓣和胫后动脉穿支螺旋桨皮瓣修复足踝部软组织缺损的临床效果。方法回顾性分析2016年1月至2019年12月陆军第80集团军医院收治的足踝部软组织缺损患者的临床资料,采用胫后动脉穿支螺旋桨皮瓣修复足踝部创面,以腓肠内侧动脉穿支螺旋桨皮瓣修复供区,遗留创面直接拉拢缝合。术后进行随访,对供、受区外观和疗效进行综合评价,分为满意、一般、不满意;评估皮瓣肿胀程度,分为Ⅰ度、Ⅱ度、Ⅲ度、Ⅳ度(肿胀程度依次加重)。结果共纳入15例患者,男11例,女4例,年龄10~65岁,平均38.4岁。内踝处创面9例,踝前创面6例。创面大小3 cm×4 cm~6 cm×10 cm。切取胫后动脉穿支螺旋桨皮瓣2 cm×8 cm~4 cm×12 cm,腓肠内侧动脉穿支螺旋桨皮瓣2 cm×6 cm~4 cm×10 cm,皮瓣均成活。术后随访3~36个月,皮瓣颜色、质地良好,与周围皮肤接近,供区仅遗留线性瘢痕。疗效评价:满意13例,一般2例。皮瓣肿胀程度评价:早期(<3个月)Ⅰ度12例,Ⅱ度2例,Ⅲ度1例;后期(3~6个月)Ⅰ度14例,Ⅱ度1例。结论腓肠内侧动脉穿支螺旋桨皮瓣和胫后动脉穿支螺旋桨皮瓣,不携带肌肉、深筋膜,对供区损伤较小,无需植皮,接力修复足踝部软组织缺损可获得较好的外形,无需二期皮瓣修整。Objective To investigate the clinical effect of the medial sural artery and posterior tibial artery perforator propeller flaps for the treatment of skin and soft tissue defects of the foot and ankle.Methods This was a retrospective study spanning over a period,from January 2016 to December 2019,conducted at the 80th Group Military Hospital.The data was focused on the cases of skin and soft tissue defects of foot and ankle repaired by posterior tibial artery perforator propeller flap,the donor site was repaired with medial sural artery perforator propeller flap,and the remaining wounds were primarily closed.Postoperative follow-up was conducted to evaluate the appearance and efficacy of donor and recipient sites,which were classified as satisfactory,neutral and dissatisfactory.The degree of swelling was evaluated and divided intoⅠ,Ⅱ,ⅢandⅣdegree(swelling degree increased in turn).Results Fifteen cases were enrolled in this study,including 11 males and 4 females.The ages of the patients ranged from 10 to 65 years,with an average of 38.4 years.The size of the defects ranged from 3 cm×4 cm to 6 cm×10 cm,including 9 cases of medial malleolus wound,6 cases of the ankle.The recipient sites included the posterior tibial artery perforator propeller flap(ranged from 2 cm×8 cm to 4 cm×12 cm)and the medial sural artery perforator propeller flap(2 cm×6 cm to 4 cm×10 cm),all the 15 cases survived.All cases were followed up from 3 to 36 months.The color and texture of the flaps were good and close to the surrounding skin.The only linear scar remains at the donor site.The outcome was satisfactory in 13 cases,neutral in 2 cases.Evaluation of flap swelling degree:flap swelling in the early stage(<3 months)wasⅠdegree in 12 cases,Ⅱdegree in 2 cases,Ⅲdegree in 1 case;in later stage(3 to 6 months)wasⅠdegree in 14 cases,Ⅱdegree in 1 case.Conclusions The medial sural artery and posterior tibial artery perforator propeller flap do not carry muscle,deep fascia,and skin grafting and take little damage to the donor si

关 键 词：穿支皮瓣 螺旋桨皮瓣 修复外科手术 显微外科手术 足 踝 

分 类 号：R658.3[医药卫生—外科学]