摘要
目的 基于下肢动脉造影图像探讨腓动脉穿支嵌合组织瓣修复小腿及足跟部复合缺损的可行性,并临床应用观察疗效。方法 以2011年5月—2014年10月期间符合标准的50例患者下肢动脉数字减影血管造影图像作为研究对象,观察腓动脉走行及其穿支血管情况。基于观测结果,2015年4月—2020年10月设计腓动脉穿支嵌合组织瓣修复7例小腿及足跟部复合缺损。其中,男5例,女2例;年龄25-55岁,平均38岁。致伤原因:交通事故伤4例,高处坠落伤2例,机器绞伤1例。小腿皮肤及胫骨缺损5例,小腿皮肤缺损范围5 cm×3 cm-11 cm×7 cm,胫骨缺损长度5-8 cm。足跟部皮肤及跟骨缺损2例,足跟皮肤缺损面积5.0 cm×4.0 cm、7.5 cm×6.5 cm,跟骨缺损面积3.0 cm×2.6 cm、4.0 cm×3.0 cm。小腿缺损者切取皮瓣范围为6 cm×4 cm-12 cm×8 cm,腓骨长度与胫骨缺损长度一致;足跟部缺损者皮瓣面积为8.5 cm×5.5 cm、13.0 cm×5.0 cm,切取腓骨长度10、12 cm;游离移植5例,带蒂移位2例。供区游离植皮修复或直接拉拢缝合。结果 影像学观测示腓动脉于腓骨头下方7.25-8.40 cm贴紧腓骨走行,并发出5-7支穿支血管,平均6.5支。穿支血管主要出现在4处,分别为距腓骨头下方(9.75±0.91)、(13.21±0.74)、(18.15±1.22)、(21.40±0.75)cm处,出现率分别为94%、90%、96%和88%。临床应用7例腓动脉穿支嵌合组织瓣全部成活,创面Ⅰ期愈合;供区植皮均成活,切口Ⅰ期愈合。患者均获随访,随访时间6-36个月,平均12个月。腓动脉穿支嵌合组织瓣外形良好、质地柔软;X线片复查示植骨均愈合良好,愈合时间6-11个月,平均7个月;随访期间未见明显骨吸收。5例患肢行走无疼痛,1例轻度疼痛伴跛行;1例术后足跟溃疡形成,穿定制足底压力分散鞋后溃疡愈合。术后6个月,按照Holden步行功能评分标准,Ⅳ级2例、Ⅴ级5例。结论 腓动脉穿支血管分布恒定,采用腓动脉穿支嵌合组织瓣修复小腿及足跟部复合缺损安全,可获得较好疗效。
Objective To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. Methods The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years(range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect.The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm×3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. Results The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels.Perforating vessels mainly appeared in four places, which were(9.75±0.91),(13.21±0.74),(18.15±1.22), and(21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months(mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation,2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. Conclusion The peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.
作者
张子阳
金文虎
全辉
祁建平
魏在荣
ZHANG Ziyang;JIN Wenhu;QUAN Hui;QI Jianping;WEI Zairong(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2022年第4期446-450,共5页
Chinese Journal of Reparative and Reconstructive Surgery
基金
贵州省创面外科整合治疗科技创新人才团队项目(黔科合平台人才[2020]5012)
遵义市科技计划项目[遵市科合社字(2018)80]。
关键词
腓动脉
穿支皮瓣
嵌合皮瓣
复合缺损
小腿
足跟
Peroneal artery
perforator flap
chimeric flap
composite defect
calf
heel
