足底内侧动脉远端蒂穿支(皮支)皮瓣在[足母]趾近节基底平面毁损伤中的应用  

Flap of distal cutaneous perforator of medial plantar artery in reconstrution of destructive defect in the base plane of proximal phalange of great toe

作　　者：周祥国 石荣剑 魏笛 袁罕 徐明亮 ZHOU Xiangguo;SHI Rongjian;WEI Di;YUAN Han;XU Mingliang(Department of Foot and Ankle Surgery,Xuzhou Renci Hospital,Xuzhou,Jiangsu Province 221006,China)

机构地区：[1]徐州仁慈医院足踝外科,江苏徐州221006

出　　处：《中华显微外科杂志》2023年第3期303-308,共6页Chinese Journal of Microsurgery

摘　　要：目的探讨应用足底内侧动脉远端蒂穿支(皮支)皮瓣在趾近节基底平面毁损伤后所致创面修复中的临床效果。方法回顾性分析徐州仁慈医院足踝外科2017年9月-2021年12月收治的26例趾近节基底水平毁损伤患者,其中男24例,女2例,年龄26~60岁,左足12例,右足14例。所有患足均为趾近节基底水平毁损后残留创面,缺损面积2.0 cm×3.0 cm~4.0 cm×5.0 cm,应用足底内侧动脉远端蒂穿支(皮支)皮瓣修复创面,保留第1跖趾关节,皮瓣切取面积平均3.2 cm×4.2 cm。供区行游离植皮。术后予抬高患肢、保暖、抗感染、消肿、抗凝、镇痛等治疗。结果所有患者均得到门诊随访,时间1~3年,术后22例皮瓣全部成活,4例皮瓣远端皮缘暗紫,予间隔拆线缓解皮瓣张力后皮瓣血运缓解,皮瓣无明显臃肿,无色素沉着,弹性好,质地较硬,耐磨,患肢无跛行,穿鞋或行走均不受限制,末次随访皮瓣受区恢复情况综合评价量表,足功能采用美国矫形足踝协会(AOFAS)评分I50评价,优24例,良2例。结论足底内侧动脉远端蒂穿支(皮支)皮瓣动脉解剖较恒定,不损伤主干动脉,血供良好,皮瓣皮肤角质层较厚,耐磨,为修复趾近节水平毁损伤所致创面增加了一个可选择的手术方式。Objective To investigate the clinical effect of perforator flap of distal cutaneous perforator of medial plantar artery in recon struction of destructive defect in the base plane of proximal phalange of great toe.Methods Twenty-six patients were treated in the Department of Foot and Ankle Surgery of Xuzhou Renci Hospital from September 2017 to December 2021.The patients were 24 males and 2 females,aged 26 to 60 years old.There were 12 defects in left foot and 14 in right foot.All the defects were the residual wounds at the first metatarsophalangeal joint with the defect at 2.0 cm×3.0 cm-4.0 cm×5.0 cm in size.The flaps pedicled with distal cutaneous perforator of the medial plantar artery were used to repair the defects,with a size at 3.2 cm×4.2 cm in average.Skin grafts were employed to repair the donor sites.Postoperative patient management including lifting the affected limbs and keeping warm,anti-infection,detumescence,anti-coagulation and pain relief.Results All patients were entered in postoperative follow-up at outpatient clinic for 1-3 years.Twenty-two flaps survived after surgery,except 4 that had dark purple edge indicating venous congestion.Blood supply of the flap was regained after the tension of the flap was relieved by interval suture removal.Appearance of flaps was good,without obvious swelling nor pigmentation,good in elasticity,in hard texture and with good wear resistance.Patients showed no limp of the affected limbs,and without restriction in wearing shoes or walking.The function of feet was evaluated according to the American Orthopedic Foot and Ankle Societ(AOFAS)I50,with 24 patients in excellent and 2 in good.Conclusion The anatomy of the flap pedicled with distal cutaneous perforator of the medial plantar artery is relatively constant.It provides a blood supply and does not affect the trunk of major artery.The flap has a thick skin cuticle hence it is wear-resistant.This flap provides a choice to the repair of a defect at proximal segment of great toe.

关 键 词：足底内侧动脉穿支(皮支) 逆行岛状皮瓣 [足母]趾毁损 软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]