横向股薄肌皮瓣游离移植修复足踝部软组织缺损  

Application of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle

作　　者：叶门勒汉·巴合苏提汉 范琛琛 王鑫[1] 阿不来提·阿不拉[1] 任鹏[1] 艾合买提江·玉素甫[1] Yemenlehan·Bahesutihan;FAN Chenchen;WANG Xin;Abulaiti·Abula;REN Peng;Aihemaitijiang·Yusufu(Department of Trauma and Microreconstructive Surgery,Orthopaedic Center,the First Affiliated Hospital of Xinjiang Medical University,Urumqi Xinjiang,830054,P.R.China)

机构地区：[1]新疆医科大学第一附属医院骨科中心显微修复外科,乌鲁木齐830054

出　　处：《中国修复重建外科杂志》2022年第6期766-769,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的 探讨横向股薄肌皮瓣游离移植修复足踝部软组织缺损的疗效。方法 2017年1月—2020年12月,采用横向股薄肌皮瓣游离移植修复16例(17足)足踝部软组织缺损。男10例,女6例;年龄23~60岁,平均38岁。左足9例,右足6例;双足1例。软组织缺损原因:交通事故伤3例,重物砸伤4例,机器伤3例,感染4例,电烧伤1例,足跟部滑膜肉瘤术后1例。创面部位:足底远端2例(2足),足跟及踝部6例(6足),足背7例(8足),第1跖趾关节至内踝部1例(1足)。创面范围为6 cm×5 cm~18 cm×7 cm。皮瓣切取范围11 cm×6 cm~21 cm×9 cm。供区直接拉拢缝合。结果 术后发生1例(1足)皮瓣血管危象,1例(1足)皮瓣边缘部分坏死,1例供区切口局部裂开,均经对症处理后愈合;其余皮瓣全部成活,供、受区创面均Ⅰ期愈合。患者均获随访,随访时间12~36个月,平均24个月。除1例皮瓣外形臃肿行二期修整外,其余皮瓣外形及质地良好、无臃肿;皮瓣均恢复保护性感觉。末次随访时,足踝功能Kofoed评分73~98分,平均89.7分;优13例、良2例、差1例,优良率93.8%。供区遗留线性瘢痕,未对下肢功能产生不良影响。结论 横向股薄肌皮瓣具有可切取范围大、血管解剖变异少、供区位置隐蔽等优势,是修复足踝部大面积软组织缺损的有效方法。Objective To investigate the effectiveness of free transverse gracilis myocutaneous flap for soft tissue defects of foot and ankle.Methods Between January 2017 and December 2020,16 cases(17 feet) of soft tissue defects of foot and ankle were repaired with free transverse gracilis myocutaneous flaps.There were 10 males and 6 females,with an average age of 38 years(range,23-60 years).There were 9 cases of left foot,6 cases of right foot,and 1 case of bilateral feet.The causes of soft tissue defect were traffic accident injury in 3 cases,heavy object smash injury in 4 cases,machine injury in3 cases,infection in 4 cases,electrical burn in 1 case,and synovial sarcoma after operation in 1 case.The wounds located at the distal plantar in 2 cases(2 feet),the heel and ankle in 6 cases(6 feet),the dorsum of the foot in 7 cases(8 feet),and the first metatarsophalangeal joint to the medial malleolus in 1 case(1 foot).The size of wounds ranged from6 cm×5 cm to 18 cm×7 cm.The size of flap ranged from 11 cm×6 cm to 21 cm×9 cm.The donor site was sutured directly.Results After operation,1 case(1 foot) of flap vascular crisis,1 case(1 foot) of partial necrosis of the flap,and 1 case of partial dehiscence of the incision at donor site occurred,all of which healed after symptomatic treatment.The other flaps survived,and the incisions at donor and recipient sites healed by first intention.All patients were followed up 12-36months(mean,24 months).Except for 1 case(1 foot) of swollen flap,which underwent two-stage trimming,the other flaps had good shape and texture.All the flaps had a protective feeling.At last follow-up,Kofoed scores of foot and ankle function ranged from 73 to 98(mean,89.7);13 cases were excellent,2 cases were good,and 1 case was poor,with an excellent and good rate of 93.8%.Linear scar was formed at the donor site without adverse effect on lower limb function.Conclusion The free transverse gracilis myocutaneous flap is an effective flap for repairing large soft tissue defects of foot and ankle due to its advanta

关 键 词：股薄肌皮瓣 横向皮瓣 足踝部 软组织缺损 创面修复 

分 类 号：R658.3[医药卫生—外科学]