腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损

doi:10.13418/j.issn.1001-165x.2017.06.018

中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (6): 681-683.doi: 10.13418/j.issn.1001-165x.2017.06.018

腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损

霍星辰¹，　刘会仁² ，　高双全¹，　穆福林³，　于占勇²张艳茂²，　王力²，　刘建华²，　高烁²

1.华北理工大学，河北唐山 063000；　2.唐山市第二医院手三科, 河北唐山 063000；
3.青龙满族自治县医院, 河北青龙 066500

收稿日期:2017-07-26 出版日期:2017-11-25 发布日期:2017-12-30
通讯作者: 刘会仁，主任医师，硕士生导师，E-mail：ssklhr@163.com
作者简介:霍星辰（1985-），男，河北秦皇岛人，在读硕士，主治医师，研究方向：手足外科，显微外科，E-mail:huoxingchen28@163.com
基金资助:
河北省医学适用技术追踪项目(G2015079)

Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for foot and ankle reconstruction

HUO Xing-chen¹, LIU Hui-ren², GAO Shuang-quan¹, MU fu-lin³，YU Zhan-yong², ZHANG Yan-mao², WANG Li², LIU Jian-hua², GAO Shuo²

1.North China University of Science and Technology, Tangshan 063000，Hebei, China； 2. The Second Hospital of Tangshan，Tangshan 063000，Hebei,China；3. Qinglong Manchu Autonomous County Hospital，Qinglong 063000， Hebei, China

Received:2017-07-26 Online:2017-11-25 Published:2017-12-30

摘要/Abstract

摘要：

目的探讨腓动脉穿支腓肠神经营养血管皮瓣逆行转移修复足踝部软组织缺损的临床治疗效果。方法　2011年11月~2014年3月，运用以腓动脉穿支腓肠神经营养血管皮瓣逆行转移修复足踝部软组织缺损31例。软组织缺损部位：踝前部12例，外踝部10例，足跟部9例。软组织缺损面积 1.0 cm×0.8 cm～18.0 cm×10.0 cm，切取皮瓣面积 2.5 cm×7.0 cm~21.0 cm×12.0 cm，供区直接闭合或游离皮片覆盖。结果术后31例皮瓣29例全部成活，2例皮瓣远端局部表层皮肤坏死，经换药治疗后愈合。平均随访19个月，所有患者伤口愈合良好，皮瓣负重区无破溃，皮瓣色泽、质地良好。恢复穿鞋、行走功能。结论　该皮瓣切取简单，血供可靠，不牺牲主要血管，修复效果满意。腓动脉穿支腓肠神经营养血管皮瓣是修复足踝部软组织缺损的理想选择。

关键词: 腓动脉穿支, 　腓肠神经营养血管皮瓣, 　足踝, 　重建

Abstract:

Objective　To investigate the clinical effects of peroneal perforator-plus pedicled sural neurofasciocutaneous flapfor retrograde repair of ankle and foot soft-tissue defects.　Methods　31 patients with soft-tissue defects in ankle and foot were treated by peroneal perforator-plus pedicled sural neurofasciocutaneous flaps from November 2011 to March 2014. The defects were in anterior ankle areas (12 cases), lateral malleolus(10 cases) and heel(9 cases). The wound area was 4.5 cm×4.0 cm～18.0 cm×10.0 cm.The flap area was 5.0 cm×4.5 cm～21.0 cm×12.0 cm. The donor areas are closed directly or in split-thickness skin grafts.　Results　29 of total 31 cases healed by first intention, and 2 cases with some distal superficial skin necrosis healed after dressing change. After an averagefollow-up of 19 months, all wounds healed well without any recurrence, and there was no ulceration in the weight-bearing area of the flap. The color and texture of the flaps were good and the shape of the pedicle was satisfactory. All patients could wear shoes and ambulate well.　Conclusion　The blood supply of this flap is reliable without sacrifice of major arteries，and the flap survival rate is not reduced. This flap is an ideal choice for repair of tissue defectsover foot and ankle.

Key words: Peroneal artery perforator；　Sural flap, 　Foot and ankle, 　Soft tissue, 　Reconstruction

霍星辰,刘会仁,高双全,穆福林,于占勇, 张艳茂,王力,刘建华,高烁. 腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损[J]. 中国临床解剖学杂志, 2017, 35(6): 681-683.

HUO Xing-chen, LIU Hui-ren, GAO Shuang-quan, MU fu-lin，YU Zhan-yong, ZHANG Yan-mao, WANG Li, LIU Jian-hua, GAO Shuo. Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for foot and ankle reconstruction[J]. Chinese Journal Of Clinical Anatomy, 2017, 35(6): 681-683.

参考文献

[1] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-21.
[2] 霍星辰, 刘会仁, 于占勇, 等. 腓肠神经营养血管皮瓣的解剖与临床应用进展[J]. 中华显微外科杂志, 2017, 40(3):309-312.
[3] 闵定宏, 张志安, 李国辉, 等. 四种逆行岛状皮瓣坏死的原因与防治[J]. 中华显微外科杂志, 2013,36(2):161-163.
[4] 徐达传, 张世民, 钟世镇. 远端蒂腓肠神经营养血管皮瓣的基础与临床研究进展[J]. 中国临床解剖学杂志, 2005, 23(4):343-344.
[5] 姚双权, 张英泽, 张奉琪, 等. 腓动脉皮支逆行岛状皮瓣的解剖与应用改进[J]. 中国修复重建外科杂志, 2006,20(9):881-883.
[6] Mojallal A, Wong C, Shipkov C, et al. Vascular supply of the distally based superficial sural artery flap: surgical safe zones based on component analysis using three-dimensional computed tomographic angiography[J]. Plast Reconstr Surg, 2010,126(4):1240-1252.
[7] Tang M, Mao Y, Almutairi K, et al. Three-dimensional analysis of perforators of the posterior leg[J]. Plast Reconstr Surg, 2009,123(6):1729-1738.
[8] Wei JW, Dong ZG, Ni JD, et al. Influence of flap factors on partial necrosis of reverse sural artery flap: a study of 179 consecutive flaps[J]. J Trauma Acute Care Surg, 2012,72(3):744-750.
[9] Wei JW, Ni JD, Dong ZG, et al. Distally based perforator-plus sural fasciocutaneous flap for reconstruction of complex soft tissue defects caused by motorcycle spoke injury in children[J]. J Trauma Acute Care Surg, 2012,73(4):1024-1027.

[10]Chang SM, Wang X, Huang YG, et al. Distally based perforator propeller sural flap for foot and ankle reconstruction: a modified flap dissection technique[J]. Ann Plast Surg, 2014,72(3):340-345.
[11]张世民, 唐茂林, 章伟文, 等. 中国穿支皮瓣的名词术语与临床应用原则共识(暂定稿)[J]. 中华显微外科杂志, 2012,35(2):89-92.
[12]Mok WL, Por YC, Tan BK. Distally Based Sural Artery Adipofascial Flap based on a Single Sural Nerve Branch: Anatomy and Clinical Applications[J]. Arch Plast Surg, 2014,41(6):709-715.
[13]陆晟迪, 柴益民. 腓肠神经营养腓动脉穿支复合组织瓣修复足底负重区软组织缺损的临床应用[J]. 中国修复重建外科杂志, 2014,28(12):1494-1497.
[14]Wei JW, Ni JD, Dong ZG, et al. A Systematic Review and Meta-Analysis of Perforator-Pedicled Propeller Flaps in Lower Extremity Defects: Identification of Risk Factors for Complications[J]. Plast Reconstr Surg, 2016,138(2):382e-383e.
[15]Stekelenburg CM, Sonneveld PM, Bouman MB, et al. The hand held Doppler device for the detection of perforators in reconstructive surgery: what you hear is not always what you get[J]. Burns, 2014, 40(8):1702-1706.
[16]章一新. 穿支血管的术前影像学导航技术[J]. 中华显微外科杂志, 2012,35(6):441-443.
[17]刘会仁, 王立新, 曹磊, 等. 以远端损伤的皮神经为蒂的逆行皮瓣修复小腿远端创面[J]. 中华显微外科杂志, 2011, 34(5):401-403.

腓动脉穿支腓肠神经营养血管皮瓣修复足踝部软组织缺损

Peroneal perforator-plus pedicled sural neurofasciocutaneous flap for foot and ankle reconstruction

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