远端腓动脉穿支皮瓣的解剖和临床应用  

Anatomical study and clinical application of distal perforator flap of calf peroneal artery

作　　者：张博闻 铁军 丁一 马国续 张梓炀 吴建科 张汉霖 康毅 赵飞[1] 黄永禄[1] ZHANG Bowen;TIE Jun;DING Yi;MA Guoxu;ZHANG Ziyang;WU Jianke;ZHANG Han lin;KANG Yi;ZHAO Fei;HUANG Yonglu(Department of Hand and Foot Reconstruction Microsurgery,People′s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China;Tongxin People′s Hospital,Wuzhong 751300,China;不详)

机构地区：[1]宁夏回族自治区人民医院手足和重建显微外科,宁夏银川750002 [2]宁夏同心县人民医院骨科,宁夏吴忠751300

出　　处：《宁夏医学杂志》2023年第11期967-969,共3页Ningxia Medical Journal

基　　金：宁夏重点研发计划项目(2019BEG3044);宁夏青年科技人才托举工程资助项目(202078);中央高校基本科研业务费专项资金项目(31920190181);宁夏科技惠民项目(2023CMG03014);宁夏回族自治区人民医院科技创新培养项目(20232)。

摘　　要：目的通过对腓动脉穿支血管的研究,依据穿支血管的分布规律,使用远端腓动脉穿支皮瓣修复足踝部的创面,观察其对创面覆盖的临床疗效。方法收集患者资料共22例,创面大小3.1 cm×1.3 cm~7.5 cm×4.6 cm。术中根据创面部位、创面状态及大小,CTA检查腓动脉穿支分布情况,术前使用Doppler超声精准定位远端穿支选择远端合适的穿支设计皮瓣,供区直接闭合,观察切取皮瓣的血供后,将皮瓣与创面无张力缝合。结果22例患者腓动脉远端穿支皮瓣存活状态良好,其中3例患者皮瓣局部出现静脉危象,后期转归。经半年随访,19例患者患肢皮瓣不臃肿,3例患者患肢皮瓣略臃肿,均未见瘢痕形成,行走无差异。采用美国AOFAS标准评价患足功能的优良率为90.90%。结论腓动脉最远端穿支近踝关节水平通过CTA及术前Doppler超声定位,其修复足踝部小面积缺损安全性较为可靠且具有距离优势、供区直接闭合、术后皮瓣色差小、美容效果佳、无臃肿、步态自然等优点,适宜临床推广。Objective To study the distribution pattern of peroneal artery perforator vessels,use the distal peroneal artery perforator flap to repair wounds on the foot and ankle,and observe its clinical efficacy in wound coverage.Methods A total of 22 patients′data were collected,with wound size approximately 3.1 cm×1.3 cm~7.5 cm×4.6 cm.During the operation,according to the location,status and size of the wound,CTA was used to check the distribution of the peroneal artery perforators.Doppler ultrasound was used to accurately locate the distal perforators before the operation,and a suitable distal perforator was selected to design a skin flap.The donor site was directly closed and the skin is harvested.After the blood supply of the flap is obtained,the skin flap and the wound surface were sutured without tension.Results The survival status of distal peroneal artery perforator flaps in 22 patients was good,among which three patients had local venous crisis in the flaps and had late outcomes.After six months of follow-up,the affected limb flaps of 19 patients were not swollen,and the affected limb flaps of three patients were slightly swollen.No scar formation was seen in any of the patients,and there was no difference in walking.The excellent and good rate of evaluating foot function using the American AOFAS standard was 90.90%.Conclusion The most distal perforator of the peroneal artery is at the level of the ankle joint.It is relatively safe to repair small defects in the ankle and has distance advantages through CTA and preoperative doppler ultrasound positioning.The donor site is directly closed,and the color difference of the postoperative skin flap is small.It has the advantages of good cosmetic effect,no bloat,and natural gait,and is suitable for clinical promotion.

关 键 词：远端腓动脉穿支皮瓣 小面积缺损 临床应用 显微外科 

分 类 号：R658.3[医药卫生—外科学]