摘要
目的探讨改良胫后动脉穿支皮瓣修复足踝内侧皮肤软组织缺损的临床应用效果。方法2017年6月至2022年5月采用改良胫后动脉穿支皮瓣修复足踝内侧皮肤软组织缺损22例,缺损面积(5 cm×4 cm)~(14 cm×11 cm)。结果本组行急诊一期修复5例,二期修复17例。设计皮瓣旋转点位于内踝与跟腱中点上5 cm者12例,位于内踝与跟腱中点上10 cm者10例。皮瓣切取面积(7 cm×5 cm)~(16 cm×12 cm),切取时间29~42 min,平均(35.0±3.6)min。术后21例皮瓣完全成活,1例皮瓣远端部分坏死,经换药后延迟愈合。术后随访6~24个月,平均(12.0±3.6)个月。皮瓣色泽正常,质地良好,厚薄适中,皮瓣无臃肿,无溃疡发生。8例吻合隐神经后感觉恢复较好,2点辨别觉10~20 mm,其余14例大部分恢复感觉。皮瓣后期无整形,患足穿鞋及行走正常。术后踝-后足功能AOFAS评分69~94分,平均(79.0±8.2)分,其中优11例,良8例,可3例,优良率为86.36%。结论改良胫后动脉穿支皮瓣修复具有创伤小、简单易取、血供可靠等优点,是修复足踝内侧皮肤软组织缺损的一种较理想的方法。
Objective To investigate the clinical effect of modified posterior tibial artery perforator flaps in the repairing of medial skin and soft tissue defects of foot-ankle.Method From June 2017 to May 2022,a total of 22 cases with medial ankle wounds were repaired with modified posterior tibial artery perforator flaps,with the skin defect area ranged from 5 cm×4 cm to 14 cm×11 cm.Results Emergency primary repair was performed in 5 cases and secondary repair in 17 cases.Of which,the rotation point was designed at 5 cm above the midpoint between the medial malleolus and achilles tendon in 12 flaps,and at 10 cm above the midpoint between the medial malleolus and achilles tendon in 10 flaps.The area of skin flap harvesting was 7 cm×5 cm to 16 cm×12 cm,and the harvesting time was 29 to 42 min with an average of 35.0±3.6 min.21 flaps survived completely,and 1 flap occurred partial necrosis at the distal end and achieved delayed healing by change dressings.All cases were followed up for 6 to 24 with an average of 12.0±3.6 months.The skin flaps were normal in color,good in texture,moderately thick and thin,without bloating and ulceration.Sensation was recovered well in 8 cases after anastomosis of saphenous nerve with 10 to 20 mm of skin two-point discrimination,and restored in most of the other 14 cases.No plastic surgery was carried out in the flaps.The involved feet wore shoes well and walked normally.The AOFAS scored 69 to 74(mean,79.0±8.2),and the ankle function evaluation revealed excellent in 11 cases,good in 8 cases and fair in 3 cases,with the fineness rate of 86.36%.Conclusion The modified posterior tibial artery perforator flap is an ideal flap for repairing the skin and soft tissue defects of medial ankle with advantages of mini-trauma,easy harvesting,reliable blood supply and good effect.
作者
黄伟雄
李波
邓映艳
黄洁
邓求民
周文造
Huang Weixiong;LI Bo;Deng Yingyan;Huang Jie;Deng Qiumin;Zhou Wenzao(Department of Orthopedics,Loudi Second People's Hospital,Loudi 417000,Hunan,China)
出处
《中国现代手术学杂志》
2023年第2期114-117,共4页
Chinese Journal of Modern Operative Surgery
关键词
胫后动脉穿支皮瓣
足踝
皮肤软组织缺损
修复
posterior tibial artery perforator flaps
food and ankle
soft tissue defects
repairing
