中国修复重建外科杂志

中国修复重建外科杂志

腓肠内侧动脉穿支皮瓣游离移植修复前足背侧创面的研究

查看全文

目的探讨应用腓肠内侧动脉穿支皮瓣游离移植修复前足背侧创面的疗效。 方法2010年1月-2015年4月,收治16例前足背侧皮肤软组织缺损患者。男12例,女4例;年龄16~58岁,平均35岁。致伤原因:烧伤5例,交通事故伤8例,压砸伤3例。受伤至入院时间2~30 h,平均6.5 h。创面范围4 cm×3 cm~10 cm×7 cm。伴趾间关节侧副韧带、关节囊缺损3例,骨外露12例;均伴肌腱外露。采用腓肠内侧动脉穿支皮瓣游离移植修复13例,携带腓肠肌内侧头肌瓣的腓肠内侧动脉穿支复合组织瓣游离移植修复3例。皮瓣切取范围5 cm×4 cm~11 cm×8 cm。供区直接缝合或植皮修复。 结果术后皮瓣均顺利成活,创面均Ⅰ期愈合;供区植皮均成活,切口均Ⅰ期愈合。患者均获随访,随访时间6~36个月,平均11个月。皮瓣外观满意、无臃肿,重建韧带的关节稳定,未继发畸形。供区无明显凹陷。 结论腓肠内侧动脉穿支皮瓣具有穿支血管解剖相对恒定、血运可靠、可以携带肌瓣修复复合组织缺损、修复后足部外形较好等优点,是修复前足背侧创面较好方法之一。

ObjectiveTo investigate the effectiveness of the free medial sural artery perforator flap for repairing anterior dorsal foot wound. MethodsBetween January 2010 and April 2015, 16 patients with skin and soft tissue defects of the anterior foot dorsal side were treated. There were 12 males and 4 females with the average age of 35 years (mean, 16-58 years). The disease causes included burn in 5 cases, traffic accident injury in 8 cases, and crush injury in 3 cases. The time from injury to admission was 2-30 hours (mean, 6.5 hours). The wound area ranged from 4 cm×3 cm to 10 cm×7 cm; combined injury included defects of lateral collateral ligament and joint capsule in 3 cases, and bone exposure in 12 cases, and all had exposure of tendon. Wounds were repaired with the medial sural artery perforator flap in 13 cases, and with medial sural artery perforator composite tissue flap carrying of medial head of gastrocnemius muscle flap in 3 cases. The size of flaps ranged from 5 cm×4 cm to 11 cm×8 cm. The donor site was sutured directly or was repaired with skin grafting. ResultsAll flaps survived well and wounds healed with stage I; skin grafts at donor site survived and the incision healed with stage I. All patients were followed up 6-36 months (mean, 11 months). The appearance of skin flap was satisfactory, without overstaffed; the joint of reconstructed ligament was stable, without secondary deformity. There was no obvious depression at the donor site, and no effect on the function. ConclusionThe medial sural artery perforator flap has the advantages of relatively constant perforator anatomy, reliable blood supply, and carries the gastrocnemius muscle flap for repair of compound tissue defect. It is one of better ways to repair the anterior dorsal foot wound.

关键词: 腓肠内侧动脉穿支皮瓣; 足背; 创面修复

Key words: Medial sural artery perforator flap; Dorsum of foot; Wound repair

引用本文: 孙广峰, 聂开瑜, 祁建平, 金文虎, 李书俊, 张子阳, 魏在荣, 王达利. 腓肠内侧动脉穿支皮瓣游离移植修复前足背侧创面的研究. 中国修复重建外科杂志, 2016, 30(3): 378-381. doi: 10.7507/1002-1892.20160074 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. 尹光明.逆行足背动脉蒂跗外侧动脉皮瓣修复前足内侧皮肤软组织缺损.创伤外科杂志, 2012, 14(2): 153-156.
2. 宋永进, 徐伟华, 汪春阳, 等.逆行胫前动脉穿支蒂腓浅神经营养血管皮瓣修复前足创面.中国修复重建外科杂志, 2014, 28(11): 1447-1448.
3. 阚利民, 孟小光, 陈江华.低旋转点腓肠神经营养血管皮瓣修复前足软组织缺损.中国修复重建外科杂志, 2013, 27(4): 509-510.
4. 施洪臣, 章雪松, 李宝山, 等.低旋转点外踝上皮瓣修复前足软组织缺损.中国修复重建外科杂志, 2012, 26(6): 761-763.
5. 雷林革, 何如祥, 程鹏, 等.游离腓动脉穿支皮瓣修复前足皮肤缺损.中国骨伤, 2013, 26(8): 634-636.
6. Okamoto H, Sekiya I, Mizutani J, et al. Anatomical basis of the medial sural artery perforator flap in Asians. Scand J Plast Reconstr Surg Hand Surg, 2007, 41(3): 125-129.
7. 张连双, 任志勇, 史迅.吻合感觉神经穿支皮瓣移植修复足跟部软组织缺损.中国矫形外科杂志, 2013, 21(16): 1681-1683.
8. 宋晓萌, 张玮, 武和明, 等.腓肠内侧动脉穿支皮瓣修复颊癌术后缺损的初步应用.组织工程与重建外科, 2014, 10(5): 269-271.
9. 谢仁国, 汤锦波, 茅天, 等.三种修复手部创面皮瓣的临床疗效评价.中华手外科杂志, 2009, 25(4): 236-238.
10. Thione A, Valdatta L, Buoro M, et al. The medial sural artery perforators: anatomic basis for a surgical plan. Ann Plast Surg, 2004, 53(3): 250-255.
11. 谭石, 李敬府, 白志勇, 等.彩色多普勒超声在腓肠内侧动脉穿支皮瓣术前评估中的应用.中国临床医学影像杂志, 2012, 23(7): 488-491.
12. 卿黎明, 胡懿郃, 唐举玉, 等.基于数字化技术的腓肠内侧动脉穿支皮瓣血供的三维可视化重建研究.中国修复重建外科杂志, 2014, 28(6): 697-700.
13. Kao HK, Chang KP, Wei FC, et al. Comparison of the medial sural artery perforator flap with the radial forearm flap for head and neck reconstructions. Plast Reconstr Surg, 2009, 124 (4): 1125-1132.
14. Kim ES, Hwang JH, Kim KS, et al. Plantar reconstruction using the medial sural artery perforator free flap. Ann Plast Surg, 2009, 62 (6): 679-684.
15. Shimizu F, Kato A, Sato H, et al. Sural perforator flap: assessment of the posterior calf region as donor site for a free fasciocutaneous flap. Microsurgery, 2009, 29(4): 253-258.
16. 寿建国, 王诗波, 王鹏飞.游离腓肠内侧动脉穿支皮瓣修复足部组织缺损.实用骨科杂志, 2015, 21(7): 651-653.