双叶穿支皮瓣修复小儿踝及足跟部大范围组织缺损的临床研究  

Clinical study of bifoliate perforator flap in repairing extensive soft tissue defect at ankle and heel in children

作　　者：杨建亮 王国伟[2] 窦洪磊[2] YANG Jianliang;WANG Guowei;DOU Honglei(Department of Emergency Surgery,Weifang Yidu Central Hospital,Qingzhou,Shandong,262500,China)

机构地区：[1]潍坊市益都中心医院急诊外科创伤骨科,山东青州262500 [2]潍坊市益都中心医院手足踝外科,山东青州262500

出　　处：《实用手外科杂志》2025年第1期14-17,共4页Journal of Practical Hand Surgery

基　　金：潍坊市科技发展计划项目(项目编号:2022YX120);潍坊市卫健委科研项目(项目编号:WFWSJK-2024-176)。

摘　　要：目的探讨采用双叶穿支血管为蒂的局部转移皮瓣修复小儿踝及足跟部大范围组织缺损的设计方法和临床疗效。方法2018年5月-2023年12月,对7例踝及足跟部严重损伤患儿急诊施行跟骨皮质包埋跟腱法修复跟骨及跟腱,选取小腿区域两个带蒂穿支血管局部转移皮瓣组合成双叶状修复大范围缺损创面。其中,采用小腿后内侧和后外侧组合穿支皮瓣修复3例、前外侧和后内侧组合穿支皮瓣修复2例、内侧或外侧和后侧组合修复2例。结果7例皮瓣全部成活,无明显并发症出现,所有跟腱和跟骨均愈合良好,随访半年,皮瓣血供可靠,质地、弹性较好。踝关节功能恢复比较满意。皮瓣两点分辨觉达6~13 mm,平均11 mm;按美国AOFAS评估标准评价:优5例,良2例。结论小儿踝及足跟部大范围组织缺损采用跟骨皮质包埋跟腱法修复跟腱和跟骨,应用双叶穿支血管组合皮瓣修复软组织缺损,解决了一次性修复大范围创面的难题且成功率高,手术操作方法简便、可靠、安全,是修复踝及跟部大范围组织缺损比较理想的方法。Objective To explore the design method and clinical effects of bifoliate perforator flaps in repairing the extensive soft tissue defect at ankle and heel in children.Methods From May 2018 to December 2023 emergency treatment was performed on 7 children with severe ankle and heel injuries using the calcaneal cortex embedding Achilles tendon method to repair the calcaneus and Achilles tendon.Two pedicled perforating vascular flaps were selected from the lower leg area to form a double leaf shape for repairing large-scale defect wounds.Among them,3 cases were repaired using a combination of posterior medial and posterior lateral perforator flaps,2 cases were repaired using a combination of anterior lateral and posterior medial perforator flaps,and 2 cases were repaired using a combination of medial or lateral and posterior perforator flaps.Results All the operations were performed with no complications.Calcaneus and Achilles tendon had reunited well.6 months after operation,the flap had good blood supply and soft texture,ankle function was similar to the normal side,two-point discrimination was from 7 mm to 14 mm,and the average was 12 mm.According to AOFAS standard,5 cases were excellent,and 2 cases were good.Conclusion The technique of Achilles's tendon embedded in cortical bone of calcaneus is reliable.The blood supply of pedicled perforator flap is rich,and the operation is relatively easy.The application of assembling bifoliated flaps to repair large size wound solves difficulties,and its success rate is high.Moreover,it provides a promising method to restore large size ankle and heel soft tissue in children.

关 键 词：双叶 穿支皮瓣 踝及足跟部 小儿 修复 

分 类 号：R68[医药卫生—骨科学]