摘要
目的 评价负压封闭引流技术(vacuum sealing drainage, VSD)联合胫后动脉内踝上穿支皮瓣修复足踝部皮肤软组织缺损的临床效果。方法 自2016年1月至2019年12月,对25例足踝部皮肤软组织缺损伴骨或关节外露的患者采用VSD治疗联合胫后动脉内踝上穿支皮瓣修复创面。所有患者经清创后均采用VSD治疗5~17 d,待创面清洁、渗出液细菌培养结果呈阴性后,切取胫后动脉内踝上穿支皮瓣逆行转移修复创面。结果 25例皮瓣全部成活,其中3例术后早期出现皮瓣远端淤血,予以拆线减张或解除皮瓣蒂部压迫后成活2例;1例远端约1.5 cm皮缘坏死,切除后直接缝合,伤口愈合。16例供瓣区直接缝合,9例移植薄中厚皮片修复,所有供瓣区均一期愈合。随访6~20个月,受区外形良好,皮瓣较薄,质地柔软,耐摩擦,感觉功能部分恢复。不足之处是皮瓣上仍有毛发生长,影响美观。结论 采用VSD联合胫后动脉内踝上穿支皮瓣修复足踝部皮肤软组织缺损,可以快速清除感染,减少细菌定植,减轻水肿,促进肉芽组织生长;而内踝上穿支皮瓣能为足踝部创面提供良好的皮肤软组织覆盖,且不牺牲主干血管,是一种较理想的手术方法,值得在临床推广应用。
Objective To explore the clinical efficacy of vacuum sealing drainage(VSD) combined with medial supramalleolar perforator flap of posterior tibial artery in the repair of soft tissue defects at the malleolus and foot area. Methods From January 2016 to December 2019, 25 patients with skin and soft tissue defects at malleolus and foot area with bone or joint exposure were repaired by VSD combined with medial supramalleolar perforator flap of posterior tibial artery. All patients were treated by VSD for 5 to 17 days after debridement. After the wound was cleaned and the bacterial culture results of wound exudate were negative, the wound was retrograde transfer repaired by medial supramalleolar perforator flap of posterior tibial artery. Results All flaps in 25 patients survived. The distal congestion of flap in the early postoperative period occurred in 3 cases, 2 cases survived after removing the suture to reduce tension or releasing the compression of the pedicle of flap. The necrosis about 1.5 cm in the distal skin margin occurred in 1 case and healed by direct suture after resection. The donor sites of 16 cases were sutured directly and 9 cases were repaired by split-thickness skin grafts. All donor sites healed at first intention. All patients were followed up for 6 to 20 months. The appearance of recipient sites was good. The flap was relatively thin,the texture was soft and the sensory function was partially restored. The flap has property of frictional resistance. The disadvantages including hair growth on the flap, which affected the appearance. Conclusion The VSD combined with supramalleolar perforator flap of posterior tibial artery in the repair of skin and soft tissue defects at the malleolus and foot area can quickly control the infection, reduce the bacterial colonization and promote the growth of granulation tissue. The supramalleolar perforator flap provided good skin and soft tissue coverage for the wounds without sacrificing the main blood vessels. So it is an ideal surgical method and should be considerable for clinical application.
作者
霍君艺
赵卓伟
全猛
李跃军
王琛
孔令琛
李靖
HUO Jun-yi;ZHAO Zhuo-wei;QUAN Meng;LI Yue-jun;WANG Chen;KONG Ling-chen;LI Jing(Department of Burns and Plas-tic Surgery,Tangdu Hospital of Air Force Military Medical University,Xi'an 710038,China)
出处
《中国美容整形外科杂志》
CAS
2020年第11期672-675,共4页
Chinese Journal of Aesthetic and Plastic Surgery
