中国修复重建外科杂志

中国修复重建外科杂志

腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤

查看全文

目的探讨腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤的疗效。 方法2012年4月-2014年10月,收治7例足部贯通伤患者。男5例,女2例;年龄21~43岁,平均31.5岁。致伤原因:压砸伤4例,钝器穿刺伤2例,火器伤1例。左足4例,右足3例。纵向贯通5例,横向贯通2例。创面范围4 cm×3 cm~9 cm×7 cm。受伤至入院时间0.5~5.5 h,平均3.2 h。采用大小为5 cm×4 cm~10 cm×8 cm的腓肠内侧动脉穿支双叶皮瓣游离移植同时修复两侧创面,并重建皮瓣感觉。供区直接缝合或植皮修复。 结果术后1例发生皮瓣远端小面积坏死,经换药后成活;1例发生创面感染,经再次扩创引流后延期愈合;余5例皮瓣顺利成活,创面Ⅰ期愈合。供区植皮均顺利成活,切口均Ⅰ期愈合。术后患者均获随访,随访时间7~24个月,平均12.5个月。皮瓣质地柔软,颜色与周围正常皮肤相似,穿鞋及负重均未受影响,无破溃。供区瘢痕平坦,对功能无明显影响。末次随访时,参照英国医学研究会(BMRC)感觉功能评定标准对皮瓣感觉进行评定,其中S2 1例,S3 4例,S3+ 2例。参照美国矫形足踝协会(AOFAS)踝、足功能评分系统评定患足踝功能,AOFAS评分87~97分,平均93.6分;其中优6例,良1例。 结论腓肠内侧动脉穿支双叶游离皮瓣能同时修复足部贯通伤两侧创面,重建皮瓣感觉,是修复足部贯通伤的一种较好术式。

ObjectiveTo explore the effectiveness of the free bilobed medial sural artery perforator (BMSAP) flap to repair penetrating wound of the foot. MethodsBetween April 2012 and October 2014, 7 cases of foot penetrating wounds were treated with the BMSAP flap. There were 5 males and 2 females, aged from 21 to 43 years (mean, 31.5 years). The causes of injury included the crush injury (4 cases), blunt puncture (2 cases), and firearm injury (1 case). The wound was located at the left foot in 4 cases and at the right foot in 3 cases. There were longitudinal penetrating injury in 5 cases and transverse penetrating injury in 2 cases. The size of wound ranged from 4 cm×3 cm to 9 cm×7 cm. The interval between injury and admission was 0.5-5.5 hours (mean, 3.2 hours). The free BMSAP flap of 5 cm×4 cm-10 cm×8 cm in size was used to repair the wounds on both sides and to reconstruct the sensation. The donor site was sutured or repaired with skin graft. ResultsAfter operation, 1 case had distal flap necrosis, the flap survived after dressing change; 1 case had wound infection, and delayed healing was obtained after drainage; and the flap survived completely, and primary healing was obtained in the other 5 cases. The skin grafts survived and healing of incision by first intention was observed at donor sites. The patients were followed up from 7 to 24 months (mean, 12.5 months). The flap had soft texture and similar color to normal skin. According to the British Medical Research Council (BMRC) sensory function assessment system, 1 case was rated as S2, 4 cases as S3, and 2 cases as S3+. The American Orthopaedic Foot and Ankle Society (AOFAS) score was 86-97 (mean, 93.6); the results were excellent in 6 cases and good in 1 case. ConclusionThe free BMSAP flap is very suitable to repair penetrating wound of the foot. The flap has the advantages of repairing the two wounds at the same time and reconstructing skin sensation as well.

关键词: 腓肠内侧动脉穿支皮瓣; 双叶皮瓣; ; 贯通伤; 创面修复

Key words: Medial sural artery perforator flap; Bilobed flap; Foot; Penetrating injury; Wound repair

引用本文: 郑大伟, 黎章灿, 曹广超, 吴尧, 石荣剑, 孙峰, 寿奎水. 腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤. 中国修复重建外科杂志, 2015, 29(12): 1519-1522. doi: 10.7507/1002-1892.20150325 复制

登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 苏日宝, 安洪宾, 王秀会, 等. 第一跖背动脉皮瓣串联趾腓侧皮瓣移植修复手部贯通伤. 中国修复重建外科杂志, 2014, 28(12):1567-1568.
2. 肖鹏康, 丰德宽, 王涛, 等. 哑铃状双叶皮瓣修复合并组织缺损的手部贯通伤. 中国修复重建外科杂志, 1997, 11(4):226-228.
3. Ju J, Hou R. Reconstruction of penetrating injuries of the hand with dorsalis pedis composite free flaps:a series of 23 patients. J Plast Reconstr Aest Surg, 2012, 65(10):1368-1376.
4. Cavadas PC, Sanz-Giménez-Rico JR, Gutierrez-de la Cámara A, et al. The medial sural artery perforator free flap. Plast Reconstr Surg, 2001, 108(6):1609-1617.
5. 刘娟, 郑怀远, 陈江海, 等. 应用游离腓肠内侧动脉穿支皮瓣修复足部小面积溃疡. 中华显微外科杂志, 2013, 36(6):573-575.
6. Zheng H, Liu J, Dai X, et al. Free conjoined or chimeric medial sural artery perforator flap for the reconstruction of multiple defects in hand. J Plast Reconstr Aest Surg, 2015, 68(4):565-570.
7. 唐茂林, 徐永清, 张世民. 穿支皮瓣的应用解剖与临床. 北京:科学出版社, 2013:103-104, 244-248.
8. Kim HH, Jeong JH, Seul JH, et al. New design and identification of the medial sural perforator flap:an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5):1609-1618.
9. Susan E, Mackinnon A, Lee Dellon. 周围神经外科学. 朱家恺, 卢传新, 王书成, 等译. 海口:三环出版社, 1991:35-38.
10. 刘鸣江, 唐举玉, 吴攀峰, 等. 逆行腓肠神经营养血管皮瓣的感觉重建. 中华显微外科杂志, 2011, 34(3):194-197.
11. Kitaoka HB, Alexander IJ, Adelaar RS, et al. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int, 1994, 15(7):349-353.
12. 邹林, 蔡锦方, 刘立峰, 等. 小腿外侧腓骨皮瓣交腿修复合并血管损伤的大段胫骨骨感染及缺损. 中华骨科杂志, 2012, 32(7):675-680.
13. 黄东, 欧阳海洋, 吴伟炽, 等. 足部皮肤软组织缺损皮瓣修复的选择. 中华显微外科杂志, 2013, 36(6):577-579.
14. 曹广超, 郑大伟, 孙峰, 等. 预构感觉皮瓣修复足跟软组织撕脱伤. 中国修复重建外科杂志, 2015, 29(2):198-201.
15. 李军, 范新宇, 朱跃良, 等. 几种方法修复前足软组织缺损的疗效分析. 中华创伤杂志, 2014, 30(11):1100-1102.
16. 赵国红, 谢振军, 孙华伟, 等. 腓肠内侧动脉穿支皮瓣修复小腿中上段软组织缺损. 中华显微外科杂志, 2013, 36(4):372-374.
17. Wang X, Mei J, Pan J, et al. Reconstruction of distal limb defects with the free medial sural artery perforator flap. Plast Reconstr Surg, 2013, 131(1):95-105.
18. Dusseldorp JR, Pham QJ, Ngo Q, et al. Vascular anatomy of the medial sural artery perforator flap:a new classification system of intra-muscular branching patterns. J Plast Reconstr Aesthet Surg, 2014, 67(9):1267-1275.
19. 张功林, 陈克明, 龚铁军, 等. 腓肠内侧动脉为蒂双叶肌皮瓣移植术. 国际骨科学杂志, 2012, 33(2):137-138.
20. Chang H, Minn KW, Imanishi N, et al. Effect of venous superdrainage on a four-territory skin flap survival in rats. Plast Reconstr Surg, 2007, 119(7):2046-2051.
21. 徐永清, 范新宇. 穿支皮瓣临床应用的若干问题探讨. 中华创伤杂志, 2014, 30(11):1082-1084.
22. 刘传波, 黄瑶, 叶俊娜, 等. 糖尿病足溃疡预后相关因素研究. 中华创伤杂志, 2014, 30(4):291-297.
23. 潘佳栋, 王欣, 梅劲, 等. 游离腓肠内侧动脉穿支皮瓣修复手足皮肤软组织缺损. 中华显微外科杂志, 2012, 35(2):93-95.