穿支血管螺旋桨皮瓣用于儿童足跟部软组织修复30例分析  

Analysis on perforating vessel propeller flap used in soft tissue repair of heel in 30 children

作　　者：杨永强 谢书康 李阳杰 刘娟娟 刘峰 YANG Yongqiang;XIE Shukang;LI Yangjie;LIU Juanjuan;LIU Feng(Department of Hand microsurgery,Foot and Ankle Surgery;Department of Joint and sports Medicine;Department of Gerontology,Qujing Municipal First People's Hospital,Qujing Yunnan 655000,China)

机构地区：[1]曲靖市第一人民医院手显微外科、足踝外科,云南曲靖655000 [2]曲靖市第一人民医院关节与运动医学科,云南曲靖655000 [3]曲靖市第一人民医院老年医学科,云南曲靖655000

出　　处：《云南医药》2024年第1期22-25,共4页Medicine and Pharmacy of Yunnan

基　　金：云南省科技厅昆医联合专项(202201AY070001-218);曲靖市第一人民医院科研课题一般项目(2021YJKTY08)。

摘　　要：目的探讨穿支血管螺旋桨皮瓣用于儿童足跟部轮辐伤软组织缺损修复的疗效。方法连续入选2020年1月-2022年12月因足跟部轮辐伤收住曲靖市第一人民医院30例患儿(男性18例、女性12例、年龄4~14岁、平均8.3岁、皮肤软组织缺损面积2.0×3.5cm~4.0×7.5cm)的临床资料、治疗经过、疗效指标,均术前血管超声造影探查小腿穿支血管并做标记。17例行胫后动脉穿支血管蒂螺旋桨皮瓣修复,13例行腓动脉穿支血管蒂螺旋桨皮瓣修复,观察伤口愈合情况。术前和末次随访均完成VAS评分和AOFAS评分。结果30例患者随访6~24个月、平均15.6月。发生2例皮瓣远端部分坏死,其余患者皮瓣成活,皮瓣无感染,色泽、质地良好,创面Ⅰ期愈合。末次随访时踝关节疼痛及功能明显改善,平均VAS评分从术前5.33±0.19分降为末次随访1.50±0.09分(P<0.001)。平均AOFAS评分从术前46.83±1.13分升达随访结束时92.27±0.58分(P<0.001)。结论穿支血管螺旋桨皮瓣应用于儿童足跟部轮辐伤软组织缺损修复安全、高效,值得推广。Objective To investigate the therapeutic effect of perforating vessel propeller flap used in soft tissue defect repair of heel spoke injury in children.Methods Clinical data,treatment process,and efficacy indicators of 30 children(18 males,12 females,aged 4~14 years,average 8.3 years,with skin and soft tissue defect area of 2.0cm×3.5cm~4.0cm×7.5cm)admitted to the Qujing Municipal First Hospital from January 2020 to December 2022 were consecutive selected.Preoperative vascular contrast-enhanced ultrasound was used to examine and label the perforating vessel of the lower leg.17 cases were repaired with posterior tibial artery perforating vessel propeller flap and 13 cases were repaired with peroneal artery perforating vessel propeller flap.The wound healing was observed regularly after surgery.Visual analogue scale(VAS)and the ankle and posterior foot scores of the American Orthopaedic Foot and Ankle Association(AOFAS)score were completed before surgery and at the last follow-up.Results 30 patients were followed up for 6 to 24 months,with an average of 15.6 months.The other flaps survived except 2 cases having distal partial necrosis.The flap had no infection,good color and texture,and the wound healed in stage I.At the last follow-up,ankle pain and function were significantly improved,the average VAS score decreased from 5.33±0.19 before surgery to 1.50±0.09 at the last follow-up(P<0.001).The average AOFAS score increased from 46.83±1.13 before surgery to 92.27±0.58 at the last follow-up(P<0.001).Conclusions The application of perforating vessel propeller flap to repair soft tissue defect of heel spoke injury in children is safe,efficient and worthy of promotion.

关 键 词：皮瓣 血管造影 足跟部轮辐伤 儿童 软组织修复 

分 类 号：R726.5[医药卫生—儿科]