端侧吻合法在游离腓肠内侧动脉穿支皮瓣中的应用  

Application of end-to-side arterial anastomosis in transplantations of medial sural artery perforator flap

作　　者：邱海胜[1] 倪晓[2] 余方正 张雷[3] QIU Haisheng;NI Xiao;YU Fangzheng;ZHANG Lei(Department of Hand Surgery,Peripheral Neurosurgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou,Zhejiang 325000,China;不详)

机构地区：[1]温州医科大学附属第一医院手外科、周围神经外科,浙江温州325000 [2]温州医科大学附属第一医院创面修复科 [3]温州医科大学附属第一医院关节外科

出　　处：《中华全科医学》2024年第11期1846-1849,共4页Chinese Journal of General Practice

基　　金：浙江省基础公益研究计划项目(LBY21H060001)。

摘　　要：目的探讨动脉端侧吻合的游离腓肠动脉穿支皮瓣移植修复手足部软组织缺损的临床疗效。方法选取2015年3月—2023年7月温州医科大学附属第一医院手外科采用腓肠内侧动脉穿支皮瓣修复手足部软组织缺损创面患者16例。所有患者均为受区一条主干血管已损伤或主干血管太粗无法匹配腓肠内侧动脉。皮瓣切取面积为(3.0 cm×5.0 cm)~(12.0 cm×7.0 cm),供区均直接缝合。其中动脉均采用腓肠动脉与受区主干血管的端侧吻合。修复足部创面时,皮瓣供区选同侧小腿;修复手部创面时,皮瓣供区可选同侧或对侧小腿。结果16块皮瓣动脉均顺利吻合,皮瓣均顺利成活,本组病例未发生血管危象。术后随访2个月~3年,平均1年,皮瓣无明显回缩,皮瓣色泽与受区相似,质地良好,肢体血供佳,感觉正常。16例供区均直接缝合,均愈合良好,仅留线型疤痕。末次随访时手部功能评定:9例为优,3例为良;足部功能评定:4例均为优;16例患者对供区及受区皮瓣外观均满意。结论游离腓肠动脉穿支皮瓣不损伤供区主干血管,相对隐蔽,中小皮瓣供区均能直接缝合,损伤较小。应用端侧吻合的游离腓肠动脉穿支皮瓣既不用考虑受区血管的匹配,又能减少受区主干血管的损伤,提高皮瓣的成活率。此术式是临床修复手足部创面的良好方法。Objective To explore the clinical efficacy of free medial sural artery perforator flap transplantation for repairing soft tissue defects in the hands and feet.Methods In the Department of Hand Surgery at the First Affiliated Hospital of Wenzhou Medical University from March 2015 to July 2023,we used free medial sural artery perforator flaps to repair hand and foot wounds in 16 cases.All patients had either damaged or overly thick main blood vessels in the recipient area that were incompatible with the medial sural artery.The flap sizes ranged from(3.0 cm×5.0 cm)to(12.0 cm×7.0 cm).The donor sites were directly sutured.The arteries are anastomosed end-to-end between the gastrocnemius artery and the main blood vessels of the recipient area.For foot wounds,the flap donor site was from the ipsilateral leg,whereas for hand wounds,the flap donor site could be from either the ipsilateral or contralateral leg.Results All 16 flap arteries were successfully anastomosed,and the flaps survived smoothly without vascular crises.During follow-up,which ranged from 2 months to 3 years(average of 1 year),the flaps showed no significant shrinkage and they maintained good shape.The skin flap had similar color and texture to the recipient area,with a good blood supply and normal sensation.All 16 donor areas were directly sutured and healed well,with only linear scars.At the final follow-up,hand function was rated as excellent in 9 cases and good in 3 cases,while all 4 cases of toot wounds were rated excellent.All 16 patients were satisfied with the appearance of both the donor and recipient skin flaps.Conclusion The free medial sural artery perforator flap does not damage to the main blood vessels of the donor area and is relatively concealed.Small to medium-sized flaps can be directly sutured,minimizing donor area damage.The use of end-to-end anastomosis with the free anterolateral thigh perforator flap eliminates the need to match recipient vessels,reduces damage to the recipient's main vessels,thereby increasing flap survival.Thi

关 键 词：腓肠内侧动脉穿支皮瓣 皮肤移植 血管吻合 显微外科技术 创面修复 

分 类 号：R622.1[医药卫生—整形外科]