跗外侧动脉岛状皮瓣修复踝关节周围软组织缺损伤  

Repair of soft tissue defect around ankle with lateral tarsal artery island flap

作　　者：胡富华 金飞燕 侯桥 姚平[1] 刘晴晴 HU Fuhua;JIN Feiyan;HOU Qiao;YAO Ping;LIU Qingqing(Department of Plastic Surgery,Hangzhou Plastic Surgery Hospital,Hangzhou 310000,China;Hand Surgery Department,Jiangnan Hospital Affiliated to Binjiang College,Zhejiang University of Traditional Chinese Medicine,Hangzhou,311200,China)

机构地区：[1]杭州整形医院整形美容科,杭州310000 [2]浙江中医药大学滨江学院附属江南医院手外科,杭州311200

出　　处：《中华显微外科杂志》2022年第4期406-410,共5页Chinese Journal of Microsurgery

摘　　要：目的探讨应用跗外侧动脉岛状皮瓣修复踝关节周围软组织缺损的手术方法及治疗效果。方法自2013年7月至2020年12月, 浙江中医药大学滨江学院附属江南医院手外科应用跗外侧动脉岛状皮瓣修复踝关节周围软组织缺损伤12例, 其中外伤后软组织缺损伴骨或肌腱外露6例, 骨折内固定术后软组织坏死内置物外露6例, 软组织缺损面积为6.0 cm×4.0 cm~9.0 cm×5.0 cm。所有创面一期清创, 待坏死组织界限清晰后, 二期行跗外侧动脉岛状皮瓣进行修复, 皮瓣的切取面积为7.0 cm×5.0 cm~10.0 cm×6.0 cm。皮瓣切取后, 将血管蒂分离至足背动脉起始处, 通过皮下隧道转移至踝部创面, 其中1例因血管蒂不够长, 术中在跗外侧动脉发起处以远结扎并切断足背动脉, 以足背动脉近端为蒂进行带蒂转移。供区均切取髂腹股沟处全厚皮片植皮修复。术后常规给予预防感染、抗凝等对症治疗, 术后通过门诊、电话、微信或上门等方式随访, 了解皮瓣质地、外观、感觉、供区及踝关节功能恢复情况。结果 12例皮瓣及供区植皮全部成活, 伤口良好愈合, 无溃疡发生。术后随访时间6~108个月, 平均17个月, 皮瓣质地优良, 外形不臃肿, 感觉恢复至S2~S3。结论应用跗外侧动脉岛状皮瓣修复修复踝关节周围软组织缺损, 供区隐蔽, 操作简单, 安全性高, 皮瓣质地、外观与受区接近, 是一种较好的方法。Objective To investigate the surgical method and therapeutic effect on repairing soft tissue defects around ankle with lateral tarsal artery island flap.Methods From July 2013 to December 2020,the lateral tarsal artery island flap were used to repair the soft tissue defects around ankle in 12 patients in Hand Surgery Department,Jiangnan Hospital Affiliated to Binjiang College.Of which,6 patients had soft tissue defects complicated with bone or tendon exposure after injury and 6 had skin necrosis with internal fixation after fracture.The area of soft tissue defects was 6.0 cm×4.0 cm-9.0 cm×5.0 cm,and the size of the flaps was 7.0 cm×5.0 cm-10.0 cm×6.0 cm.After the flap was freed,the vascular pedicle was separated up to the origin of dorsalis pedis artery.As the pedicel was not long enough in 1 patient,the dorsal pedis artery was ligated and transected at the origin of the lateral tarsal artery.Full thickness skin graft was used to repair the donor sites.The patients were treated with anti-infection and anticoagulant therapies.The postoperative follow-ups were conducted by outpatient clinic visit,telephone or WeChat interviews or home visit to observe the recoveries in texture,appearance,sensation,donor site and function of ankle.Results All the flaps and skin grafts survived.The wound healed well without occurrence of ulcer.The follow-up ranged 6-108 months(mean 17 months).Appearance of the flaps was good.It was not bloated and the sensation was restored to S2-S3.Conclusion It is a good method to apply the lateral tarsal artery island flap in repair of the soft tissue defects around ankle.It features a hidden donor site,simple operation and the high level of safety.The texture and appearance of the flap are close to those of the recipient site.

关 键 词：跗外侧动脉岛状皮瓣 踝关节 软组织缺损 修复 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]