CTA辅助腓动脉穿支螺旋桨皮瓣在小腿创面修复中的应用  

Application of peroneal artery perforator propeller flap in the repair of lower leg wounds assisted by CTA

作　　者：林剑 王扬剑[2] 徐毅 魏鹏[2] 郑雪红[2] 张伟平 Lin Jian;Wang Yangjian;Xu Yi;Wei Peng;Zheng Xuehong;Zhang Weiping(Ningbo University,Ningbo 315000,China;Department of Repair and Reconstruction,Ningbo First Hospital,Ningbo 315000,China;Department of Hand and Foot Surgery,Ningbo Zhenhai Second Hospital,Ningbo 315000,China)

机构地区：[1]宁波大学,宁波315000 [2]宁波市第一医院修复重建外科,宁波315000 [3]宁波镇海第二医院手足外科,宁波315000

出　　处：《中华手外科杂志》2023年第2期140-143,共4页Chinese Journal of Hand Surgery

基　　金：浙江省医药卫生项目(2022KY1111)。

摘　　要：目的探究CTA辅助腓动脉穿支螺旋桨皮瓣修复小腿皮肤组织缺损的临床效果。方法自2019年1月至2020年12月我院收治21例小腿皮肤软组织缺损患者,男13例,女8例。小腿外侧9例,外踝6例,小腿前内侧6例。缺损面积3 cm×7 cm~8 cm×9 cm,所有患者均采用腓动脉穿支螺旋桨皮瓣修复创面,术前常规行下肢CTA检查,定位穿支走行、管径大小、长度、穿出位点,以距离创面最近的合适穿支血管设计螺旋桨皮瓣,供区创面植皮覆盖或直接关闭。结果本组21例患者通过术前CTA检查均找到可用的腓动脉穿支血管,以距离创缘最近的合适穿支血管为轴心设计穿支螺旋桨皮瓣修复小腿创面,3例供区局部取皮植皮覆盖,18例直接关闭。术后随访6~24个月,1例皮瓣远端部分坏死,经清创、换药等对症处理后顺利存活,其余皮瓣均存活良好,供区愈合良好,疗效满意。结论采用CTA辅助腓动脉穿支螺旋桨皮瓣修复小腿创面,供区的穿支血管定位更加精确,可以大大减少血管变异对手术的影响,最大程度保证皮瓣成活率。Objective To explore the clinical efficacy of CTA-assisted peroneal artery perforator propeller flap in repairing skin tissue defects of the lower leg.Methods From January 2019 to December 2020,21 patients with skin and soft tissue defects in the lower leg were treated in our hospital,including 13 males and 8 females.There were 9 cases on the lateral side of the lower leg,6 cases on the lateral ankle,and 6 cases on the anteromedial side of the lower leg.The defect area ranged from 3 cm×7 cm to 8 cm×9 cm.All the wounds were repaired by the peroneal artery perforator propeller flap.Before the operation,the lower extremity CTA was routinely performed to locate the route,diameter,length,and location of the perforator.The propeller flap was designed with the nearest appropriate perforator vessel to the wound.The donor site wound was covered with skin graft or closed directly.Results The peroneal artery perforator vessel was found through preoperative CTA examination in all the 21 patients.The perforator propeller flap was designed with the appropriate perforator vessel closest to the wound edge as the axis to repair the leg wound.The local skin grafting was performed in 3 cases and directly closed in 18 cases.The postoperative follow-up ranged from 6 to 24 months.There was one case of distal partial necrosis of the flap,which survived after debridement,dressing change and other symptomatic treatments.The other flaps survived well,and the donor site healed well with satisfactory results.Conclusion Using CTA-assisted peroneal artery perforator propeller flap to repair the lower leg wound,the location of the perforator vessels in the donor site is more accurate,which can greatly reduce the influence of vascular variation on the operation and ensure the survival rate of the flap to the greatest extent.

关 键 词：外科皮瓣 显微外科手术 CTA 腓动脉 创面修复 

分 类 号：R658.3[医药卫生—外科学]