中国修复重建外科杂志

中国修复重建外科杂志

“网球拍”状内踝上穿支螺旋桨皮瓣修复跟踝部软组织缺损疗效观察

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目的 总结“网球拍”状内踝上穿支螺旋桨皮瓣修复跟踝部软组织缺损的疗效。 方法 2011 年 6 月—2016 年 6 月,收治 50 例跟踝部软组织缺损患者。男 40 例,女 10 例;年龄 6~58 岁,中位年龄为 35.6 岁。缺损原因:外伤 44 例,外伤后瘢痕畸形 2 例,慢性溃疡 2 例,鳞癌 2 例。缺损部位:足跟部 20 例,踝部 15 例,跟踝部 15 例。软组织缺损范围为 3.5 cm×2.0 cm~13.0 cm×10.0 cm。病程 3 h~2 个月,平均 28 d。采用“网球拍”状内踝上穿支螺旋桨皮瓣修复,皮瓣切取范围 3.8 cm×2.2 cm~13.4 cm×10.3 cm。供区直接缝合(5 例)或植皮修复(45 例)。 结果 术后皮瓣均顺利成活,创面Ⅰ期愈合。供区 1 例植皮部分坏死,经换药后愈合;其余植皮均顺利成活,切口均Ⅰ期愈合。术后 48 例获随访 12 个月,皮瓣修复处外形、功能恢复良好,感觉恢复良好。 结论 “网球拍”状内踝上穿支螺旋桨皮瓣成活率高,血供可靠,移位后能恢复感觉,是修复跟踝部缺损较理想的方式之一。

Objective To investigate effectiveness of the medial ankle branches propeller " Tennis racket-like” flap in repair of heel-ankle tissue defect. Methods Between June 2011 and June 2016, 50 patients with heel-ankle tissue defects were treated. There were 40 males and 10 females, with a median age of 35.6 years (range, 6–58 years). The defects were caused by trauma in 44 cases, scar deformity after trauma in 2 cases, chronic ulcer in 2 cases, and squamous cell carcinoma in 2 cases. The defects located at heel in 20 cases, ankle in 15 cases, and heel-ankle in 15 cases. The size of heel-ankle tissue defect ranged from 3.5 cm×2.0 cm to 13.0×10.0 cm. The course of disease ranged from 3 hours to 2 months (mean, 28 days). All wounds were repaired by the medial ankle branches propeller " Tennis racket-like” flap in a size of 3.8 cm×2.2 cm–13.4 cm×10.3 cm. The donor site was directly sutured in 5 cases or repaired by skin grafting in 45 cases. Results All flaps survived and wounds healed by first intention. Partial necrosis of skin grafting occurred in 1 case, and the wound recovered by change dressing. The other skin grafting survived and wounds healed by first intention. Forty-eight patients were followed up 12 months after operation. The appearance, sensory, and function of repaired heel-ankle flaps were satisfactory. Conclusion For heel-ankle tissue defect repair, the medial ankle branches propeller " Tennis racket-like” flap has advantages of the high survival rate, reliable blood supply, and sensory recovery.

关键词: 内踝上穿支皮瓣; 螺旋桨皮瓣; 跟踝部缺损

Key words: Medial ankle branches flap; propeller flap; heel-ankle tissue defect

引用本文: 程定, 崔树英, 张成书, 李艳玲, 李恒, 王香玲, 王俊, 郑乐. “网球拍”状内踝上穿支螺旋桨皮瓣修复跟踝部软组织缺损疗效观察. 中国修复重建外科杂志, 2018, 32(11): 1450-1453. doi: 10.7507/1002-1892.201804030 复制

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