腓动脉穿支螺旋桨皮瓣在修复足踝软组织缺损中的临床应用  

Peroneal artery perforator propeller flap in repairing foot and ankle wounds

作　　者：张向超 陆兆丰 赵华山 欧昌良 Zhang Xiangchao;Lu Zhaofeng;Zhao Huashan;Ou Changliang(Emergency Department,the First Affiliated Hospital of Henan University of Science and Technology,Luoyang,Henan Province 471000;Department of Orthopedics,the First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang 550001,China)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院急诊科,河南洛阳471000 [2]贵州中医药大学第一附属医院骨科,贵阳550001

出　　处：《创伤外科杂志》2025年第3期221-224,共4页Journal of Traumatic Surgery

摘　　要：目的探讨腓动脉穿支螺旋桨皮瓣在修复足踝创面中的临床应用及效果。方法回顾性分析2019年2月—2022年9月河南科技大学第一附属医院急诊科收治的足踝软组织缺损患者15例,运用腓动脉穿支螺旋桨皮瓣进行修复。男性9例,女性6例;年龄22~60岁,平均38.5岁。道路交通伤10例,机械伤5例。创面缺损面积3.5 cm×4.5 cm~8.5 cm×10.5 cm,皮瓣切取面积4.0 cm×5.0 cm~9.0 cm×11.0 cm。手术均采取二期完成,一期予以清创后,负压吸引5~7 d,肉芽组织清洁干燥时,二期予以设计腓动脉穿支螺旋桨皮瓣修复。皮瓣供区予以直接缝合9例,接力皮瓣修复4例,植皮修复2例。术后对所有患者进行门诊或微信定期随访,随访指标包括皮瓣外形、美观、质地以及供区瘢痕。结果皮瓣顺利成活12例;术后蒂部卡压出现皮瓣血供欠佳2例,予以探查后调整蒂部,解除卡压,皮瓣成活;皮瓣术后远端少许坏死1例,经换药后愈合。随访时术后皮瓣外形美观,无明显色素沉着,无明显臃肿,质地弹性可。按照中华医学会显微外科分会皮瓣功能评定标准,优10例,良4例,中1例。皮瓣供区可见线性瘢痕,温哥华瘢痕量表(VSS)平均为(2.0±0.3)分,无功能影响。结论腓动脉穿支恒定,数量较多,血供稳定,螺旋桨皮瓣切取灵活,是修复足踝软组织缺损较为理想的方法。Objective To explore the clinical application and efficacy of peroneal artery perforator propeller flaps(PPF)in the repair of foot and ankle soft tissue defects.Methods This retrospective study was conducted on 15 cases of foot and ankle soft tissue defects,which were repaired by peroneal artery PPF in the Emergency Department of the First Affiliated Hospital of Henan University of Science and Technology from Feb.2019 to Sep.2022.There were 9 males and 6 females aged 22-60(mean 38.5)years,with 10 cases of traffic accident injuries and 5 mechanical injuries.The sizes of the defect were 3.5 cm×4.5 cm to 8.5 cm×10.5 cm,and the flaps were prepared of 4.0 cm×5.0 cm to 9.0 cm×11.0 cm.All surgeries were completed in two stages.In the first stage,after debridement,vacuum sealing drainage(VSD)was applied for 5-7 days.When the granulation tissue became clean and dry,a peroneal artery PPF was designed to repair the wound defects in the second stage.The donor sites were directly sutured in 9 cases,repaired by relay flap in 4 cases,and by skin grafting in 2 cases.All patients were followed up regularly through outpatient visits or WeChat.The follow-up indicators included the appearance,aesthetics and texture of the skin flap,and the scar at the donor site.Results Among the 15 cases,12 flaps survived smoothly;poor blood supply of the flaps was observed in 2 cases due to pedicle compression after surgery,which survived after exploration and adjustment of the pedicle to relieve compression;the remaining case reported slight necrosis at the distal end of the skin flap,which healed after dressing changes.During the follow-up,all the skin flaps had an aesthetic appearance,with no obvious pigmentation or swelling,and good texture and elasticity.According to the functional evaluation criteria for skin flaps of the Microsurgery Branch of the Chinese Medical Association,10 cases were rated as excellent,4 as good,and 1 as fair.A linear scar can be seen in the donor area,with an average score of 2.0±0.3 by the Vancouver Scar Scale(V

关 键 词：软组织缺损 腓动脉穿支 螺旋桨皮瓣 显微外科 

分 类 号：R658.3[医药卫生—外科学]