远端蒂腓骨短肌肌瓣修复踝关节周围感染性创面  

Distal pedicled peroneus brevis muscle flap for repair of infective wounds around ankle joint

作　　者：王道明 张沈屹婷 庄智勇 蔡金表 杨国劲 WANG Daoming;ZHANG Shenyiting;ZHUANG Zhiyong(Department of Hand Surgery,Fujian Quanzhou Orthopedic-Traumatological Hospital,Quanzhou,Fujian,362000,China)

机构地区：[1]泉州市正骨医院手外科,福建泉州362000

出　　处：《实用手外科杂志》2023年第4期464-466,共3页Journal of Practical Hand Surgery

摘　　要：目的 探讨远端蒂腓骨短肌肌瓣修复踝关节周围感染性创面的治疗要点及疗效。方法 2021年8月-2022年9月,治疗跟骨骨折术后骨感染4例,腓骨远端骨折术后腓骨感染1例,腓骨远端慢性骨髓炎1例,跟腱断裂术后感染1例。一期彻底清创,行抗生素骨水泥或封闭负压引流护创;二期采用远端蒂腓骨短肌肌瓣填充清创后死腔、覆盖创面,肌瓣表面用携带的肌皮瓣或游离植皮修复皮肤缺损。结果 7例患者中,肌瓣表面植皮4例,其中2例一期在肌瓣表面游离植皮,2例二期在肌瓣表面游离植皮,其中3例植皮全部成活,1例肌瓣因术后受压部分坏死,植皮未成活,再次清创植皮后创面愈合;3例以腓骨短肌皮穿支为蒂切取成远端蒂腓骨短肌皮瓣,肌皮瓣转移后未发生肌皮瓣坏死或液化。随访2~12个月,创面愈合好,质地及外形好,感染性创面未再破溃。结论 远端蒂的腓骨短肌瓣,血运可靠,能填塞踝关节周围清创术后死腔,控制感染,并同时修复此区域周围软组织缺损。手术方法简单、易行、安全可靠,是治疗感染性创面并修复软组织缺损的有效方法。Objective To explore the key points of distal pedicled peroneus brevis muscle flap in repairing infectious wounds around ankle joint.Methods From August 2021 to September 2022,we collected 4 cases of bone infection after calcaneal fracture,1 case of fibular infection after distal fibular fracture,1 case of chronic osteomyelitis of distal fibula,and 1 case of infection after Achilles tendon rupture.The first stage was thorough debridement,followed by antibiotic bone cement or vacuum sealing drainage for wound protection.In the second stage,the distal pedicled peroneus brevis muscle flap was used to fill the dead space after debridement and cover the wound.The surface of muscle flap was repaired with skin flap or free skin graft.Results Among the 7 patients,4 received skin grafting on the surface of muscle flap.Free skin grafting was performed on the surface of muscle flap in 2 cases at the first stage.Free skin grafting was performed on the surface of muscle flap in 2 cases at the second stage.In the skin graft group,3 cases survived.1 case of muscle flap necrosis occured due to postoperative compression,so that the skin graft did not survive.After debridement again,the wound healed by replantation.In 3 cases,the perforating branch of peroneus brevis musculocutaneous flap was used as the flap pedicle to form the distal peroneus brevis musculocutaneous flap.No necrosis or liquefaction of the musculocutaneous flap occurred after the transfer.Follow up for 2 to 12 months showed good wound healing,good texture and appearance,and no ulceration of infectious wound.Conclusion The distal pedicled peroneus brevis muscle flap has reliable blood supply and can fill and eliminate the dead space after debridement around the ankle joint.Not only control the infection,but also repair the soft tissue defects around this area.The operation is simple,easy,safe and reliable.It is an effective method to treat infectious wounds and repair soft tissue defects.

关 键 词：远端蒂 腓骨短肌肌瓣 踝关节 感染创面 修复 

分 类 号：R687.3[医药卫生—骨科学]