摘要
目的探讨小腿下段穿支蒂筋膜皮瓣修复老年踝关节周围大面积皮肤软组织缺损的临床疗效。 方法采用回顾性病例系列研究分析2013年11月-2017年12月上海交通大学医院附属新华医院（崇明）收治的23例老年踝关节周围皮肤软组织缺损患者临床资料，其中男13例，女10例；年龄65-78岁，平均71岁。踝关节周围创面缺损面积为13．5 cm×5．5 cm-16．0 cm×8．5 cm。根据踝关节周围缺损创面的位置、大小、形状，在小腿下段设计并切取穿支蒂筋膜皮瓣转位进行修复，皮瓣最大面积为17．0 cm×9．5 cm，最小面积为14．0 cm×6．5 cm。根据皮瓣成活、弹性色泽、外观形态、感染控制、供区瘢痕、皮肤感觉、黄环节活动、患者认可等情况，参照Tornetta等标准对足踝部疗效及功能进行评价；评定皮瓣肿胀程度。 结果21例皮瓣术后全部顺利成活，供、受区伤口Ⅰ期愈合。2例皮瓣远端发生皮缘坏死，给予换药处理，供、受区伤口均完全愈合。术后随访6—48个月，平均15个月。皮瓣成活优良，形态满意，色泽、弹性与周围正常皮肤接近，供区瘢痕较小。疗效评价满意20例，一般3例，无不满意。足踝部功能评价：优8例，良12例，可3例。皮瓣肿胀评级：早期I度16例，Ⅱ度5例，Ⅲ度2例；后期I度20例，Ⅱ度2例，Ⅲ度1例。 结论小腿下段穿支蒂筋膜皮瓣移位修复老年踝关节周围大面积皮肤软组织缺损，方法简便、安全可靠、损伤较小，可促进创面愈合和足踝部功能恢复。
Objective To evaluate the clinical effect of the perforator fascial flap of the lower leg for the repair of large skin and soft tissue defects around the ankle in the elderly. Methods A retrospective case series study was conducted on the clinical data of 23 elderly patients with skin and soft tissue defect around the ankle joint admitted to Xinhua Hospital （Chongming） Affiliated to Medical College of Shanghai Jiaotong University, from November 2013 to December 2017. There were 13 males and 10 females, aged 65-78 years （mean, 71 years）. The wound areas around the ankle joint ranged from 13.5 cmx 5.5 cm to 16.0 cm x 8.5 cm. According to the position, size, and shape of the wound area around the ankle joint of the lower leg, the perforator fascia flap was designed and transferred for repairing. The maximum flap area was 17.0 cm x 9.5 cm while the minimum area was 14. 0 cm x 6.5 cm. According to the conditions of survivals of the skin flap, elasticity, color, appearance, infection control, donor site scar, skin sensation, joint activity, patient satisfaction, etc., the ankle and foot function was evaluated by referring to Tornetta and other standards. Besides, the swelling degree of the flap was graded. Results A total of 21 flaps survived and the wound at both donor site and recipient site obtained stage I union. Two cases of skin edge necrosis occurred at the distal end of the flap, and the wounds at the donor and recipient sites were completely healed after dressing change. The patients were followed up for 6-48 months, with an average of 15 months. The flaps had good survival, satisfactory shape, and small scar at donor site, with similar elasticity and color with the surrounding normal skin. Twenty patients were satisfied with the efficacy and three were fine with the outcome. In terms of functional evaluation of the ankle and foot, the results were excellent in eight patients, good in 12, and fair in three. Flap swelling grading was as follows： degree I in 16 patients, degree II in 5, and degree III in 2 at the early stage ; degree I in 20 patients, degree II in 2, and degree III in 1 at the later stage. Conclusion In repairing large skin and soft tissue defects around the ankle in the elderly, the perforator fascia flap of the lower leg transferring is a convenient, safe, and reliable method with less damage, which can promote the wound healing and functional recovery of ankle and foot.
作者
林涧
王之江
张天浩
吴立志
Lin Jian, Wang Zhijiang, Zhang Tianhao, Wu Lizhi.(Department of Microsurgery, Xinhua Hospital （Chongming） Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 202150, China)
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2018年第10期892-897,共6页
Chinese Journal of Trauma
基金
上海市科研计划（14411973200）
上海市卫计委科研课题（201840198）
上海市崇明县科技攻关基金（CKY2015-05）
关键词
踝损伤
软组织损伤
外科皮瓣
Ankle injuries
Soft tissue injuries
Surgical flaps
