基于腓动脉后穿支及腓肠内侧与外侧皮神经营养血管嵌合组织瓣修复跟腱区复合组织缺损  

Repair of composite tissue defect in Achilles tendon area with nutrient vessel of medial and lateral sural sutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery

作　　者：周树萍 幸超峰 杨涛 张广超 熊颖杰 陈佳 李振峰 肖滋润 仓飞成 李士民 宋力 ZHOU Shuping;XING Chaofeng;YANG Tao;ZHANG Guangchao;XIONG Yingjie;CHEN Jia;LI Zhenfeng;XIAO Zirun;CANG Feicheng;LI Shimin;SONG Li(Department of Trauma and Microscopic Orthopaedics,988th Hospital of the Joint Logistics Support Force of PLA,Zhengzhou 450042,China)

机构地区：[1]联勤保障部队第九八八医院创伤显微骨科,郑州450042

出　　处：《中华显微外科杂志》2022年第4期394-399,共6页Chinese Journal of Microsurgery

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20200793)。

摘　　要：目的探讨基于腓动脉后穿支及腓肠内、外侧皮神经营养血管嵌合组织瓣修复跟腱区复合组织缺损的临床疗效。方法 2016年1月-2021年6月, 联勤保障部队第九八八医院创伤显微骨科共收治伴有跟腱缺损的感染性创面12例, 跟腱区软组织缺损面积为2.5 cm×4.5 cm~8.0 cm×12.5 cm, 跟腱缺损长度3.0~7.0 cm, 均采用以腓动脉后穿支为供血血管, 腓肠内、外侧皮神经营养血管嵌合跟腱皮瓣(ATF)修复。皮瓣切取面积3.0 cm×5.0 cm~9.0 cm×13.0 cm, 切取ATF大小3.0 cm×4.0 cm~3.0 cm×8.0 cm。供区8例直接缝合,4例行植皮修复。术后常规外固定6周, 其后去除外固定并开始逐步进行功能锻炼, 定期行门诊随访, 末次随访时采用Thermann跟腱功能评定系统进行评价。结果术中嵌合ATF切取顺利且各瓣血运好, 术后无血管危象发生, 皮瓣均顺利成活, 伤口甲级愈合。患者均获得随访10~24个月, 皮瓣外观饱满, 稍显臃肿, 色泽与受区相似, 质地柔软, 小腿及踝关节功能恢复良好。按Thermann跟腱功能评定系统进行评估, 结果优8例, 良4例。结论基于腓动脉后穿支及腓肠内、外侧皮神经营养血管的嵌合组织瓣, 可精准修复跟腱区复合组织缺损, 是临床修复伴有跟腱缺损的踝部复合软组织缺损创面的有效方法之一。Objective To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods From January 2016 to June 2021,12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics,988th Hospital of the Joint Logistics Support Force of PLA.The area of soft tissue defect around Achilles tendon was 2.5 cm×4.5 cm-8.0 cm×12.5 cm,and the length of the defect of Achilles tendon was 3.0-7.0 cm.The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap(ATF)and the posterior perforating branch of peroneal artery was used as the vessel of blood supply.The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm,and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm.The donor sites were sutured directly(8 cases)or repaired with skin graft(4 cases).External fixation were put on for 6 weeks after surgery.Then the external fixation was removed and the functional exercise gradually started.Outpatient clinic follow-ups were carried out regularly.Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results The chimeric ATF was harvested and the blood supply of each flap was good during the operation.There was no vascular crisis after surgery.The flaps survived smoothly and the wound achieved grade A healing.All patients were entered follow-up that lasted for 10-24 months.There was good appearance of flaps with minor bloating,and the colour of flaps was similar to the skin around the receiving site.The texture was soft with normal function of the lower legs and ankle.Tendon function was evaluated by Thermann Achilles tendon function assessment system,the result were 8 cases in excellent and 4 cases in good.Conclusion The nutrient vessel of medial and la

关 键 词：腓肠神经营养血管 腓动脉 嵌合组织瓣 跟腱 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]