摘要
目的探讨游离足底内侧穿支皮瓣修复足跟部负重区皮肤软组织缺损的临床效果。方法回顾性分析2011年4月至2017年11月,唐山市第二医院收治的足跟部负重区皮肤软组织缺损患者的资料,均采用游离足底内侧穿支皮瓣移植修复足跟部负重区皮肤软组织缺损,非负重区以游离植皮覆盖创面。术中以胫后动脉为小腿供区血管,动脉伴行静脉及大隐静脉为皮瓣的回流静脉,与足底内侧皮瓣血管蒂进行吻接,足底内侧神经皮支与隐神经进行吻合。皮瓣供区取全厚皮片打包缝合。术后随访观察皮瓣愈合情况、皮瓣感觉、外形、稳定性、供区瘢痕情况等。结果共纳入11例足跟部负重区皮肤软组织缺损患者,男6例,女5例,年龄24~41岁,平均31.3岁。11例患者术后皮瓣全部成活,供区创面植皮愈合。所有患者均获得11~56个月随访,平均18.5个月。末次随访时,皮瓣两点辨距觉为6~13 mm,感觉恢复、外形及功能满意,无溃疡发生,恢复正常行走。结论应用游离足底内侧穿支皮瓣修复足跟部负重区皮肤软组织缺损,具有功能恢复好、皮瓣外形及稳定性满意、可恢复足跟部保护性感觉等优点,是满足患者正常行走功能要求的有效方法。
Objective To investigate the clinical application of the free medial plantar artery perforator flap for soft tissue defect reconstruction of the weight-bearing surface of the heel.Methods The clinical data of patients with soft tissue defects in the weight-bearing surface of the heel were analyzed retrospectively,which were reconstructed with the free medial plantar artery perforator flaps in the Second Hospital of Tangshan from April 2011 to November 2017.The medial plantar artery was anastomosed with the posterior tibial artery.The venae comitantes were anastomosed with the great saphenous vein.The cutaneous branch of the medial plantar nerve was also anastomosed with the saphenous nerve.The donor sites were covered with full-thickness skin grafting.The survival condition,sensory function,countour,stability,and donor site scars were observed during follow-up.Results A total of 11 patients with soft tissue defects in the weight-bearing surface of the heel were enrolled.There were six males and five females aged 24-41 years(mean,31.3 years).All flaps survived uneventfully.Patients were followed up 11-56 months(mean 18.5 months).The appearance and function recovery of the flaps were satisfactory with 6-13 mm two-point discrimination(2-PD).No ulcer occurred.All patients returned to a normal walk.Conclusions It is a feasible way for one-staged reconstruction of the combined loss of Achilles tendon and soft tissue in the heel by using free anterolateral femoral artery perforator flap with fascia lata,which has the advantages of good functional recovery,less trauma,short curing course,the satisfactory contour,and protective sensation achievable.
作者
董惠双
张万喜
姚军
胡宏宇
张云鹏
张净宇
于志亮
高顺红
Dong Huishuang;Zhang Wanxi;Yao Jun;Hu Hongyu;Zhang Yunpeng;Zhang Jingyu;Yu Zhiliang;Gao Shunhong(Department of Hand Surgery,The Second Hospital of Tangshan,Tangshan 063000,China)
出处
《中华整形外科杂志》
CSCD
2021年第12期1378-1381,共4页
Chinese Journal of Plastic Surgery
关键词
外科皮瓣
足跟部
足底内侧皮瓣
Surgical flap
Heel
Medial plantar perforator flap
