小腿逆行腓动脉穿支皮瓣结合Ilizarov延长术治疗小腿远端再植术后皮肤坏死及短缩畸形  

Retrograde peroneal artery perforator flap combined with Ilizarov lengthening technique in the treatment of skin necrosis and shortening deformity after distal leg replantation

作　　者：张航 刘亚平 唐林俊 曾福俊 蒋国华 刁杰 刘愉川 ZHANG Hang;LIU Yaping;TANG Linjun(Department of of Hand Surgery,Sichuan Modern Hospitol,Chengdu,Sichuan,610041,China)

机构地区：[1]四川现代医院手外科,四川成都610041

出　　处：《实用手外科杂志》2023年第3期399-402,共4页Journal of Practical Hand Surgery

基　　金：四川省科技厅科研项目(项目编号:2021YJ0250)。

摘　　要：目的探讨小腿逆行腓动脉穿支皮瓣结合Ilizarov延长术治疗小腿远端离断再植术后皮肤缺损及短缩畸形的临床疗效和技术要点。方法2018年1月-2021年3月,对7例小腿短缩再植术后部分皮肤坏死的患者,采用一期逆行小腿腓动脉穿支皮瓣修复坏死皮肤,二期应用Ilizarov延长术治疗小腿短缩畸形。再植术后2~4周切取腓动脉穿支皮瓣面积:5.0 cm×14.0 cm~5.0 cm×20.0 cm;穿支供区直接拉拢闭合。肢体短缩4.5~7.5 cm,平均5.5 cm;再植术后10~28周行肢体延长术,延长时间1.5~2.75个月,平均2.2个月。术后随访评估膝关节和踝关节功能。结果术后腓动脉穿支皮瓣伤口均一期愈合,皮瓣成活良好;7例均获随访18~36个月,平均24个月。其中2例肢体延长后与健侧等长,5例肢体延长后与健侧肢体长度相差<2.0 cm,延长段骨矿化好,肢体离断处骨折均愈合;足底感觉于末次随访时恢复至S4级2例,S3级5例。根据Paley评定标准评定:优4例,良2例,可1例。结论一期腓动脉穿支皮瓣修复小腿远端再植术后皮肤坏死,手术操作简单,皮瓣成活率高,结合二期Ilizarov外支架纠正小腿短缩畸形,术后双下肢基本等长,患肢功能恢复良好,是治疗小腿再植术后皮肤坏死及短缩畸形的较好方法。Objective To investigate the clinical efficacy and technical points of the reverse peroneal artery perforator flap combined with Ilizarov lengthening technique in the treatment of skin necrosis and shortening deformity after distal leg replantation.Methods From January 2018 to March 2021,7 patients with partial skin necrosis after replantation of leg shortening were treated with one-stage retrograde peroneal artery perforator flap to repair the necrotic skin and Ilizarov lengthening to treat leg shortening deformity in the second stage.Area of peroneal artery perforator flap:5.0 cm×14.0 cm~5.0 cm×20.0 cm;The donor site was closed directly and the flap operation was performed 2-4 weeks after replantation.The lower leg was 4.5~7.5 cm shorter,with an average of 5.5 cm;Limb lengthening was performed 10 to 28 weeks after replantation,with an average of 2.2 months(1.5 to 2.75 months).Follow up to assess knee and ankle function.Results In 7 patients after operation,the wound of peroneal perforator flap healed in one stage and the flap survived well;Seven patients were followed up from 18 to 36 months,with an average of 24 months.Among them,2 cases were as long as the healthy side after limb lengthening,and 5 cases were less than 2cm long than the healthy side after limb lengthening.The bone healing of the lengthened segment was good,and the fractures of all the severed limbs healed;The plantar sensation recovered to S4 in 3 cases and S3 in 4 cases at the last follow-up.According to Paley's evaluation criteria,4 cases were excellent,2 cases were good,and 1 case was fair.Conclusion The primary peroneal artery perforator flap can be used to repair the skin necrosis after the distal leg replantation.The operation is simple and the survival rate of the flap is high.Combined with the secondary Ilizarov lengthening operation,the leg shortening deformity is corrected.After the operation,both legs were basically equal in length,and the affected limb recovered well.It was a good method to treat the skin necrosis and shortening

关 键 词：小腿离断 断指再植 穿支皮瓣 肢体延长术 

分 类 号：R658.3[医药卫生—外科学]