改良腓动脉中低位螺旋桨穿支皮瓣修复踝周皮肤软组织缺损

doi:10.13418/j.issn.1001-165x.2019.04.019

摘要/Abstract

摘要： 目的　探讨改良腓动脉中低位螺旋桨穿支皮瓣修复踝周皮肤软组织缺损的临床效果。方法　从2016年9月至2018年1月，收治踝周皮肤软组织缺损患者18例，采用改良腓动脉中低位螺旋桨穿支皮瓣修复，术前便携式多普勒探测穿支并定位，设计改良螺旋桨皮瓣，以腓动脉主干为皮瓣轴线，以穿支为界分为较大的皮瓣头部（大桨）和较小的皮瓣尾部（小桨），将旋转点至创面距离作为大桨长度，皮瓣宽度为大桨长度的1/2~2/3，大桨的长宽比不超过2：3。以大桨修复踝周皮肤软组织缺损，小桨修复大桨创面。术中保留腓肠神经及小隐静脉。踝周软组织缺损创面范围为3.0 cm×3.0 cm~10.0 cm×4.5 cm，腓动脉中低位穿支皮瓣面积为5.0 cm×3.0 cm~23.0 cm×5.0 cm。术后观察受区及供区的外形及功能，评价临床效果。结果　18例皮瓣均I期成活，16例患者获随访，随访时间7~21个月，平均13个月。皮瓣色泽、质地良好，两点辨别觉7~11 mm，供、受区外形满意。患者穿鞋及行走不受影响，足外侧感觉及足部回流正常，患足AOFAS评分92~97分，平均94分。结论　改良腓动脉中低位螺旋桨穿支皮瓣血供可靠，避免皮瓣远端坏死的同时最大程度地保护了供区，是修复踝周皮肤软组织缺损的理想方式。

关键词: 腓动脉, 　穿支皮瓣, 　软组织缺损, 　创面修复, 　足踝

Abstract: Objective　To investigate the clinical effect of the modified mid-low propeller perforator flap of the peroneal artery in repairing skin and soft tissue defects around the ankle.　Methods　From September 2016 to January 2018, 18 patients with soft-tissue defects around the ankle underwent the modified mid-low propeller perforator flap of the peroneal artery to repair the wound. Preoperative detection and localization of the perforator were achieved using the portable Doppler, and the modified propeller flap was harvested. The main trunk of the peroneal artery was used as the axis of the flap. The perforator was used as the boundary to divide the flap into a large head (large paddle) and a smaller head (small paddle). The distance from the perforator to the wound was used as the length of the large paddle. The width of the flap was 1/2~2/3 of the length of the large paddle, and the length-width ratio of the large paddle was not more than 2:3. Large heads were used to repair soft tissue defects around ankle and small heads were used to repair wounds resulted from the harvest of large heads. The sural nerve and the small saphenous vein were preserved during operation. The area of the soft tissue defects around the ankle ranged from 3.0 cm×3.0 cm to 10.0 cm×4.5 cm. And the area of the modified mid-low propeller perforator flap was 5.0 cm×3.0 cm to 23.0 cm×5.0 cm. The clinical effect was evaluated by observing the shape and function of the recipient site and donor site.　Results All 18 cases survived successfully in the first stage of the flap, and 16 cases were followed up. The follow-up time ranged from 7 to 21 months (mean 13 months). The flap was good in luster and texture. The two-point discrimination perception ranged from 7 to 11 mm. The appearance of the affected area was satisfactory. The patients' shoes and ambulation were not affected. The lateral sensation of foot and foot reflex were normal. The AOFAS score of the affected foot was 92 to 97, with an average of 94.　Conclusions　The modified mid-low peroneal propeller perforator flap is an ideal way to repair the skin and soft-tissue defects around the ankle. It can avoid the distal necrosis of the flap and protect the donor area as much as possible.

Key words: Peroneal artery, 　Perforator flap, 　Soft tissue defect, 　Wound repair, 　Ankle

中图分类号:

邓长华, 孔繁福, 伍真, 聂萌, 祁占军. 改良腓动脉中低位螺旋桨穿支皮瓣修复踝周皮肤软组织缺损[J]. 中国临床解剖学杂志, 2019, 37(4): 454-456.

DENG Chang-hua, KONG Fan-fu, WU Zhen, NIE Meng, QI Zhan-jun. Repair of skin and soft tissue defects around ankle with modified mid-low propeller perforator flap of peroneal artery[J]. Chinese Journal of Clinical Anatomy, 2019, 37(4): 454-456.

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