游离胫后动脉穿支皮瓣修复前足软组织缺损13例  

Repair of soft tissue defect of forefoot with free posterior tibial artery perforator flap:Report of 13 cases

作　　者：王国忠 吴翮[2] 董全宇 屈志刚 高飞[1] 毕本军 张钊[1] 潘月海 黄恒[1] WANG Guozhong;WU He;DONG Quanyu;QU Zhigang;GAO Fei;BI Benjun;ZHANG Zhao;PAN Yuehai;HUANG Heng(Department of Hand and Foot Surgery,Affiliated Hospital of Qingdao University,Qingdao,Shandong Province 266000,China;Surgery Department,Women and Children's Hospital,Qingdao University,Qingdao,Shandong Province 266000,China)

机构地区：[1]青岛大学附属医院手足外科,山东青岛266000 [2]青岛大学附属妇女儿童医院外科中心,山东青岛266000

出　　处：《中华显微外科杂志》2022年第3期266-270,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨游离胫后动脉穿支皮瓣修复前足软组织缺损的临床应用效果。方法 2017年1月-2021年1月,回顾性研究前足软组织缺损伴跖骨头外露但前足横弓完整性存在的患者13例,其中男9例,女4例,年龄(40.0±13.0)岁;损伤原因:8例交通事故损伤,5例重物砸伤。7例前足软组织缺损、足趾毁损,6例前足皮肤撕脱伤、足趾开放性骨折伴有肌腱、血管、神经损伤;创面面积为4.5 cm×3.0 cm~8.0 cm×6.0 cm。一期行VSD处理,二期采用游离胫后动脉穿支皮瓣覆盖,皮瓣面积为5.5 cm×4.0 cm~9.0 cm×7.0 cm。术后1、2、3、6个月门诊复查,随后门诊、电话或微信随访。根据皮瓣外观、质地、感觉恢复及美国矫形外科足踝协会(AOFAS)踝-后足功能评分系统评价手术效果。结果 13例皮瓣全部成活,随访6~24个月,足部形态良好,可负重行走,皮瓣外观满意,无磨损破溃。5例感觉恢复到S3,6例感觉恢复到S2,2例感觉恢复到S1。AOFAS踝-后足功能评分,4例为优,7例为良,2例可。结论游离胫后动脉穿支皮瓣具有穿支较恒定、中上段穿支血管蒂较长、皮瓣可重建部分感觉、保留了足弓外形及负重支撑点、行走和负重良好等优点,是前足软组织缺损较好的修复方式。Objective To investigate the clinical effect of free posterior tibial artery perforator flap in repair of forefoot soft tissue defect.Methods From January 2017 to January 2021,a retrospective study was conducted on 13 patients with forefoot soft tissue defect,metatarsal head exposed,and forefoot transverse arch integrity,including 9 males and 4 females.The age was(40.0±13.0)years old.Cause of injury:8 cases of traffic accident injury,5 cases of heavy object smashing injury.Seven cases had forefoot skin defect and toe damage,and 6 cases had forefoot skin avulsion injury,open toe fracture with tendon,blood vessel and nerve injury.The wound area was 4.5 cm×3.0 cm-8.0 cm×6.0 cm.VSD treatment was performed in the first stage,and free posterior tibial artery perforator flap was used for the second stage.The flap area was 5.5 cm×4.0 cm-9.0 cm×7.0 cm.Outpatient reviews scheduled at 1,2,3,and 6 months after surgery,through outpatient clinic,telephone or WeChat.The flaps were evaluated according to appearance,texture,sensory recovery,and the American Orthopaedic Foot and Ankle Society(AOFAS)ankle-hind foot function scoring system.Results All 13 flaps survived.The follow-up lasted for 6 to 24 months.The feet were in good shape,walking with weight beries,and the flaps had satisfactory appearance without wear and tear.Five cases were S3,6 were S2,and 2 were S1.According to AOFAS ankle-hindfoot function score,4 had excellent scores,7 were in good,and 2 in fair.Conclusion The free posterior tibial artery perforator flap has relatively constant perforators,and the pedicle of the middle and upper perforators is longer,and the flap can build part of the sensation.Posterior artery perforator flap is a good flat for repairing the soft tissue defects of the metatarsal head of the forefoot.

关 键 词：胫后动脉穿支皮瓣 足 软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]