小腿穿支皮瓣修复足踝部皮肤软组织缺损  

Application of Leg Perforator Flaps Grafting for Repairing of Soft Tissue Defects of Foot and Ankle

作　　者：刘江涛 黄书润[1] 欧阳容兰[1] 王一勇 LIU Jiang-tao;HUANG Shu-run;OUYANG Rong-lan;WANG Yi-yong(Department of Burns and Plastic Surgery, 910th Hospital, Joint Logistics Support Force of Chinese PLA, Quanzhou 362000, Fujian, China)

机构地区：[1]中国人民解放军联勤保障部队第910医院烧伤整形科,福建泉州362000

出　　处：《中国现代手术学杂志》2022年第2期114-119,共6页Chinese Journal of Modern Operative Surgery

摘　　要：目的探讨小腿穿支皮瓣修复足踝部皮肤软组织缺损创面的临床效果。方法2018年2月至2020年10月我科收治足踝部皮肤软组织缺损伴肌腱或骨质外露患者32例,分别采用腓肠神经营养皮瓣、腓动脉穿支皮瓣、胫后动脉穿支皮瓣三种小腿穿支皮瓣修复创面。皮瓣面积约(5.0 cm×6.0 cm)~(16.0 cm×12.0 cm)。结果本组行腓肠神经营养皮瓣修复13例,腓动脉穿支皮瓣修复9例,胫后动脉穿支皮瓣修复10例;供瓣区取中厚皮片移植修复29例,直接缝合3例。所有患者穿支皮瓣均成活,仅1例腓动脉穿支皮瓣、1例胫后动脉穿支皮瓣远端发生回流障碍后引起皮瓣坏死,面积小于1.0 cm×2.0 cm,经换药2周后治愈。30例患者术后随访6~24个月,患者术区皮瓣质地柔软,与周缘皮肤颜色接近,无明显色素沉着,皮瓣弹性、韧性、耐磨性及耐寒性良好,足踝关节活动良好,行走基本正常。12例患者因皮瓣臃肿、穿鞋袜不适,二期行皮瓣修薄手术。结论小腿穿支皮瓣血供明确,手术操作相对简便,皮瓣成活率高,术后外形、质地、功能恢复良好,是治疗足踝部皮肤缺损较为满意的方法,值得临床推广应用。Objective To investigate the clinical effect of leg perforator flaps grafting in the repair of skin and soft tissue defects of foot and ankle.Methods From February 2018 to October 2020,a total of 32 cases with skin and soft tissue defects of foot and ankle with tendon or bone exposure were treated in our hospital.Three kinds of leg perforator flaps were grafted to repair the wounds,including sural neurotrophic flap,peroneal artery perforator flap and posterior tibial artery perforator flap.The flap area ranged from 5.0 cm×6.0 cm to 16.0 cm×12.0 cm.Results There were 13 cases repaired with sural neurotrophic flap,9 cases with peroneal artery perforator flap,and 10 cases with posterior tibial artery perforator flap.The donor area was sutured directly in 3 cases and repaired by medium thickness skin grafting in 29 cases.All the perforator flaps survived,and only one case of peroneal artery perforator flap and one case of posterior tibial artery perforator flap appeared necrosis due to distal reflux disorder with the area less than 1.0 cm×2.0 cm,and were cured by dressing change for two weeks.30 patients were followed up for 6 to 24 months.The flap was soft,appeared similar color of the surrounding skin,and had good elasticity and toughness without obvious pigmentation.All cases restored normal function of foot and ankle.12 patients underwent secondary skin flap thinning operation due to bloated skin flap and discomfort in wearing shoes and socks.Conclusion The leg perforator flaps grafting is a satisfied method for repairing the skin and soft tissue defects of lower extremity with reliable blood supply,relatively simple operating,high survival rate of flap,and good postoperative appearance,texture and function recovery,and which is worthy of clinical application.

关 键 词：足踝部 软组织缺损 小腿穿支皮瓣 腓肠神经营养皮瓣 腓动脉穿支皮瓣 胫后动脉穿支皮瓣 

分 类 号：R658.3[医药卫生—外科学]