带蒂踝周穿支皮瓣修复中足离断再植创面4例  

Replantation of severed midfoot with pedicled perforator flap around ankle for repair traumatic defect:Report of 4 cases

作　　者：王伟[1] 艾合买提江·玉素甫[2] WANG Wei;AIHEMAITIJIANG Yusufu(Department of Micro-orthopaedics,The Second Affiliated Hospital of Luohe Medical Collage,Luohe,Henan Province 462300,China;Department of Microsurgery,Repair and Reconstruction,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]漯河医学高等专科学校第二附属医院显微骨科,河南漯河462300 [2]新疆医科大学第一附属医院显微修复重建外科,乌鲁木齐830054

出　　处：《中华显微外科杂志》2023年第2期157-162,共6页Chinese Journal of Microsurgery

基　　金：河南省高校重点支持项目(16A320040)。

摘　　要：目的探讨早期应用带蒂踝周穿支皮瓣在复杂中足离断再植中的应用。方法2017年5月至2020年12月,漯河医学高等专科学校第二附属医院显微骨科收治合并软组织损伤的复杂断足共4例,均为男性。年龄34~53岁,平均44岁。左足2例,右足2例。玉米收割机皮带绞伤1例,钢质重物砸伤3例。离断部位:经跗骨间3例,经跖骨基底部1例;伤后至入院时间2.0~5.0 h,平均3.5 h;均采用顺行法再植,剩余的足背软组织缺损创面于急诊或早期采用踝周穿支皮瓣修复,皮瓣大小7.5 cm×8.0 cm~9.0 cm×19.0 cm。术后定期门诊或网络随访,观察再植足及皮瓣的外观、质地、色泽和血运。足踝部功能评估根据美国足踝外科协会(AOFAS)踝-后足量表评分。结果本组4例患者均获得随访,其中3例再植成活,1例因皮肤坏死、创面感染、血管栓塞导致断足缓慢坏死,后行坏死前足解脱,延期行内踝上穿支皮瓣修复创面。4例患者共行5块皮瓣均成活,皮瓣外观饱满,质地、色泽良好,创面Ⅰ期愈合,植皮均成活。随访时间13~36个月,平均19.5个月。4例患者均可无辅助行走,感觉功能恢复S3。其中再植失败者1例行走时步态轻微跛行。至末次随访时,足踝部功能根据AOFAS踝-后足量表评分,结果优2例,良1例,可1例。结论早期应用带蒂踝周穿支皮瓣修复复杂中足离断再植后软组织创面是一种有效、可行的治疗策略。ObjectiveTo discuss the pedicled perforator flap around ankle in complicated replantation of severed traumatic midfoot.MethodsFrom May 2017 to December 2020,a total of 4 patients with severed midfoot combined with severely traumatic soft tissue defects were treated in the Department of Micro-orthopaedics,The Second Affiliated Hospital of Luohe Medical Collage.The patients were all males and aged from 22 to 53(mean,44)years old.Two patients had left foot injured and 2 in right foot.Causes of injuries:One patient was injured by strangulation of a corn harvester belt,and 3 were crushed by a heavy steel bar.Three patients had the severed sites at the level of intertarsal joint and 1 at the base of metatarsus.The time from injury to admission was 2.0-5.0(mean,3.5)hours.The severed feet were replanted by anterograde method.Pedicled perforator flaps around ankle were used to repair the soft tissue defects of feet in emergency surgery or post first-stage surgery.The sizes of the flaps were 7.5 cm×8.0 cm-9.0 cm×19.0 cm.Scheduled follow-ups were arranged at outpatient clinic or by online reviews.Appearance,texture,colour,blood supply and sensory-motor function of the replanted feet and flaps were observed.The function of the foot and ankle was evaluated according to the American Orthopaedic Foot Ankle Association(AOFAS).ResultsAll 4 patients engaged follow-ups lasted for 13-36(mean,19.5)months.Three replantations survived after surgery.In the other case,a chronic necrosis of the broken foot was caused by skin necrosis,wound infection,and vascular embolism.And then the necrotic forefoot was released,and the wound was later repaired with a flap based medial supramalleolar branches.A total of 5 flaps in 4 patients survived.All flaps were in good appearance with good texture and colour.All flaps healed primarily,and all skin grafts survived.All of the 4 patients could walked without assistance.Sensation restored to S3.The patient with a failed replantation had left with a mild claudication.According to AOFAS,2 patients were

关 键 词：撕脱伤 断足再植 穿支皮瓣 带蒂皮瓣 踝周部 显微外科技术 

分 类 号：R658.3[医药卫生—外科学]