应用游离腓动脉穿支皮瓣修复老年患者指背感染性溃疡创面  

Reconstruction of infective ulcer wouds in dorsal fingers of the elderly patients with free peroneal artery perforator flap

作　　者：张伟 梁高峰 贾宗海 贾钟喻 张满盈 段超鹏 滕云升 郭永明 Zhang Wei;Liang Gaofeng;Jia Zonghai;Jia Zhongyu;Zhang Manying;Duan Chaopeng;Teng Yunsheng;Guo Yongming(Department of Hand Surgery,Norinco General Hospital,Xi’an 710065,China)

机构地区：[1]兵器工业总医院手外一科,西安710065

出　　处：《中华显微外科杂志》2025年第1期45-49,共5页Chinese Journal of Microsurgery

基　　金：陕西省重点研发计划(2023-YBSF-001)。

摘　　要：目的探讨应用游离腓动脉穿支皮瓣修复老年患者指背感染性溃疡并软组织缺损的手术方法及临床效果。方法2016年3月至2022年6月,兵器工业总医院手外一科应用游离腓动脉穿支皮瓣修复老年患者手指背侧感染性溃疡并软组织缺损创面13例,男11例,女2例;年龄65~70岁,平均66.5岁。感染原因:糖尿病所致10例,外伤所致3例。感染部位:示指7例,中指3例,环指3例。清创后软组织缺损面积为2.0 cm×4.5 cm~2.0 cm×5.5 cm,伴有肌腱及骨质外露。皮瓣供区为对侧小腿,皮瓣切取面积为2.5 cm×5.0 cm~2.5 cm×6.0 cm,供区创面直接缝合。所有患者均随访,观察内容包括皮瓣外观、感觉及手指活动度。结果本组皮瓣均顺利成活,创面均一期愈合,感染无复发,12例患者获得门诊随访,随访时间12~27个月,平均21.6个月,皮瓣外观及手指功能满意,皮瓣感觉恢复到S_(2)级5例、S_(3)级7例,手功能评分根据中华医学会手外科学会上肢部分功能评定试用标准评定,优8例,良4例。结论游离腓动脉穿支皮瓣具有血管解剖恒定、血供可靠、皮瓣厚薄适中、供区可直接缝合等优点,是修复老年患者指背感染性溃疡创面的有效方法。Objective To investigate a surgical method and clinical effect on reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients with free perforator flap of peroneal artery.MethodsFrom March 2016 to June 2022,13 elderly patients with infective ulcer and soft tissue defects in dorsal fingers were reconstructed with free perforator flaps of peroneal artery.The patients were 65-70 years with an average age of 66.5 years.Cause of infection:10 ulceration and soft tissue defects were caused by diabetes and 3 by injury.Seven infective ulceration and soft tissue defects were in dorsal index fingers,3 in dorsal middle fingers and 3 in dorsal ring fingers with the size of soft tissue defects at 2.0 cm×4.5 cm-2.0 cm×5.5 cm with an exposure of tendon and phalange.The donor site of the flaps was of contralateral calf and the flaps were 2.5 cm×5.0 cm-2.5 cm×6.0 cm in size.All donor sites were sutured directly.All patients were included in the postoperative follow-up at outpatient clinic to observe the appearance and sensation of the flap as well as finger movement.ResultsAll flaps survived and all wounds achieved stage I healing,without recurrence of infection.Twelve patients had the postoperative follow-up for 12 to 27 months,with an average of 21.6 months.There were satisfactory appearance of flaps and the function of fingers.Sensation of flaps recovered to S_(2) in 5 patients and S_(3) in 7 patients.The recovery of hand function was evaluated according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,with 8 hands in excellent and 4 in good.ConclusionThe free perforator flap of peroneal artery has advantages of constant vascular anatomy,reliable blood supply,moderate thickness and direct closure of donor site.It is a useful clinical method in reconstruction of infective ulcer and soft tissue defects in dorsal fingers of the elderly patients.

关 键 词：腓动脉穿支皮瓣 老年 指背 感染性溃疡 修复 

分 类 号：R658.3[医药卫生—外科学]