摘要
目的探讨胫前动脉近端骨膜穿支骨皮瓣修复手足复合组织缺损的临床疗效。方法自2015年3月至2017年10月,我们采用胫前动脉近端骨膜穿支骨皮瓣游离移植修复手足复合组织缺损24例,其中手部12例,足部12例。合并肌腱损伤6例,关节缺损1例。皮肤缺损面积为3.0cm×0.8cm^10.0cm×5.5cm,骨质缺损大小1.7cm×1.5cm×1.0cm^5.0cm×1.0cm×1.0cm。胫骨前缘距胫骨结节(3.2±0.8)cm处为穿支入皮点,以此为中心设计骨皮瓣。术后根据Michigan手功能评价标准随访手功能,按照Maryland足部评分标准进行足功能评估。结果移植骨皮瓣全部存活,其中21例获得随访,时间为6~24个月,平均12.3个月,3例失访。皮瓣质地柔软,弹性好,厚薄适中,肤色接近正常皮肤,末次随访时皮瓣感觉恢复至S2~S3;两点分辨觉为6~11mm,平均8.9mm。3例指端皮瓣二期修薄。手指外形及功能恢复良好。移植骨皮瓣愈合时间为2~4个月,平均2.3个月,无延迟及不愈合情况发生。小腿及足负重行走无影响。Michigan手功能评分8例优良,Maryland足部评分12例优良。结论胫前动脉近端骨膜穿支位置恒定,其骨皮瓣适合修复手足等部位中小面积复合组织缺损。
Objective To investigate the clinical efficacy of proximal periosteal perforator boneskin flap of anterior tibial artery for repair of the composite tissue defects of the hand and foot. Methods March 2015 to October 2017, 24 cases of the composite tissue defects of the hand and foot were repaired by free transplantation of the proximal periosteal perforator bone-skin flap of anterior tibial artery, including 12 cases of hand and 12 cases of foot. There were 6 cases of tendon injury and 1 case of joint defect. The skin defect area ranged from 3.0 cm × 0.8 cm to 10.0 cm × 5.5 cm. The size of bone defects ranged from 1.7 cm × 1.5 cm × 1.0 cm to 5.0 cm × 1.0 cm × 1.0 cm. The anterior tibial margin of the talus-tibial tubercle (3.2 ±0.8) cm was the penetrating point, and the bone-skin flaps were designed with this as the center. After operation, hand function was followed up according to Michigan Hand Function Evaluation Standard, and foot function was evaluated according to Maryland Foot Score Standard. Results All the flaps survived, of which 21 cases were follow-up for 6 to 24 months, with an average of 12.3 months, and 3 cases were lost. The skin flaps were soft, elastic, moderately thick and nearly normal skin. At the last follow-up, the sensation of the flaps restored to S2 to S3. The two-point discrimination was 6 to 11 mm, with an average of 8.9 mm. Two-stage thinning operation of fingertip flaps was performed in 3 cases. Finger shape and function recovered well. The healing time of the transplanted bone and skin flaps ranged from 2 to 4 months, with an average of 2.3 months. No delayed or nonunion occurred. There was no influence on leg and foot weight-bearing walking. Michigan hand function score was excellent and good in 8 cases and Maryland foot score was excellent and good in 12 cases. Conclusion The proximal periosteal perforator of anterior tibial artery has a constant position. Its bone and skin flaps are suitable for repairing small and medium-sized composite tissue defects in hand and foot.
作者
魏义涛
梁海华
钟桂午
姚捷
孙芳芹
梁翊
Wei Yitao;Liang Haihua;Zhong Guiwu;Yao Jie;Sun Fangqin;Liang Yi(Department of Hand and Foot Surgery,Dongguan Chang'an Xin'an Hospital,Guangdong 523800,China)
出处
《中华手外科杂志》
CSCD
北大核心
2019年第5期361-363,共3页
Chinese Journal of Hand Surgery
关键词
外科皮瓣
治疗结果
胫前动脉
骨膜穿支
复合组织缺损
Surgical flaps
Treatment outcome
Anterior tibial artery
Periosteal perforator
Composite tissue defects
