腓动脉穿支蒂螺旋桨皮瓣修复足踝部软组织缺损  

Repair of soft tissue defect of ankle and foot with propeller flap pedicled with perforating branch of peroneal artery

作　　者：张锦涛 张洁 李建梅 杨伟超 王春旭 李晓妮 王芳 刘刚义 ZHANG Jintao;ZHANG Jie;LI Jianmei;YANG Weichao;WANG Chunxu;LI Xiaoni;WANG Fang;LIU Gangyi(Department of Hand and Microsurgery,Baoji Third Hospital,Baoji,Shanxi Province 721000,China)

机构地区：[1]宝鸡第三医院手显微外科,陕西宝鸡721000

出　　处：《中华显微外科杂志》2022年第6期613-616,共4页Chinese Journal of Microsurgery

基　　金：宝鸡市卫生健康委员会科研计划项目(2021-060)。

摘　　要：目的探讨腓动脉穿支蒂螺旋桨皮瓣移植修复足踝部软组织缺损的临床疗效。方法2018年8月至2021年8月,对宝鸡第三医院手显微外科收治的15例足踝部软组织缺损伤采用腓动脉穿支蒂螺旋桨皮瓣进行移植修复,其中足跟部7例,外踝部6例,踝前2例。软组织缺损范围3.0 cm×3.5 cm~5.5 cm×4.0 cm,皮瓣切取大小5.0 cm×4.5 cm~12.0 cm×6.0 cm。7例供区通过小桨辅助直接关闭,其余供区经拉拢缝合缩小创面后,采用中厚皮片覆盖。术后通过门诊、电话或微信随访其临床疗效,按美国足踝外科协会(AOFAS)Marylad评分评价其功能恢复。结果15例皮瓣中,2例皮瓣远端坏死,经换药愈合;1例皮瓣肿胀、静脉瘀滞持续2周后消退;其余12例皮瓣顺利成活。术后随访6~24个月,平均12个月。末次随访时皮瓣外形、质地良好,并恢复保护性感觉;足踝部恢复正常屈、伸及负重功能。根据AOFAS-Marylad评分标准,功能恢复优9例,良4例,可2例。结论采用腓动脉穿支蒂螺旋桨皮瓣移植修复足踝部软组织缺损,简单易行、安全可靠,不牺牲肢体主干血管,且皮瓣血供可靠,是修复足踝部软组织缺损的理想术式。Objective To investigate the clinical effect of propeller flap pedicled with perforating branch of peroneal artery in repairing soft tissue defects of ankle and foot.Methods From August 2018 to August 2021,15 cases of soft tissue defect of ankle and foot were repaired with propeller flap pedicled with perforating branch of peroneal artery in the Department of Hand and Microsurgery,Baoji Third Hospital.Among them,there were 7 cases with soft tissue defect in heel,6 cases in lateral ankle and 2 cases in front of ankle.The size of defects was 3.0 cm×3.5 cm-5.5 cm×4.0 cm,and the size of flaps was 5.0 cm×4.5 cm-12.0 cm×6.0 cm.In 7 cases,the donor sites were closed directly with the aid of small paddle.The donor sites in other cases were covered with medium thickness skin graft after the wounds were narrowed by pull-up suture.The clinical efficacy was evaluated by follow-up at outpatient clinic and via telephone or WeChat interviews.Functional recovery was evaluated according to the American Orthopedic Foot Ankle Society(AOFAS)-Marylad.Results Among the 15 flaps,2 had distal necrosis and healed after dressing change;One flap was swelling and had venous osculation,but relived 2 weeks later.The rest of the 12 flaps survived smoothly.At the final follow-up:the shape and texture of the flap were good,and the protective feeling was restored;The ankle also recovered the normal flexion,extension and weight-bearing.According to the AOFAS-Marylad,function recovery were excellent in 9 cases,good in 4 cases,and fair in 2 cases.Conclusion It is simple,safe and reliable to repair the soft tissue defect of foot and ankle with propeller flap pedicled with perforating branch of peroneal artery.It does not sacrifice the main blood vessels of limb,and the blood supply of the flap is reliable.It is an ideal operation for repairing the soft tissue defects of ankle and foot.

关 键 词：腓动脉穿支皮瓣 螺旋桨皮瓣 软组织缺损 足踝部 显微外科手术 

分 类 号：R658.3[医药卫生—外科学]