中国修复重建外科杂志

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小腿后侧宽蒂双动力皮瓣治疗前足皮肤软组织缺损

高秋明 , 薛云 , 时培晟 , 周顺刚 , 邓晓文 , 刘锐 , 沈伟伟 , 黄强 , 李闯兵 , 石杰

解放军兰州总医院全军创伤骨科中心（兰州　730050）

收稿日期: 2018-03-26;  修回日期:2018-07-24; 

通讯作者: 高秋明, Email: gaoqm001@sohu.com

Effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of soft tissue defect of forefoot

GAO Qiuming , XUE Yun , SHI Peisheng , ZHOU Shungang , DENG Xiaowen , LIU Rui , SHEN Weiwei , HUANG Qiang , LI Chuangbing , SHI Jie

Orthopaedic Trauma of Orthopaedic Center, Lanzhou General Hospital of Chinese PLA, Lanzhou Gansu, 730050, P.R.China

Corresponding Author: GAO Qiuming, Email: gaoqm001@sohu.com

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目的 总结小腿后侧宽蒂双动力皮瓣治疗前足皮肤软组织缺损的临床经验。 方法 2011 年 3 月—2017 年 3 月，采用小腿后侧宽蒂双动力皮瓣修复 18 例前足严重皮肤软组织缺损。男 13 例，女 5 例；年龄 11～49 岁，平均 33 岁。缺损原因：外伤 16 例，伤后至入院时间 3～72 h，平均 15 h；马蹄内翻足矫形术后、足部开放性骨折术后感染各 1 例。前足足底缺损 11 例、前足背侧缺损 7 例。软组织缺损范围为 6 cm×4 cm～15 cm×9 cm。18 例均合并骨、关节或肌腱外露，4 例合并骨折。皮瓣切取范围为 8 cm×5 cm～17 cm×10 cm。供区创面游离植皮修复。 结果 手术时间 100～190 min，平均 140 min。术后 17 例皮瓣全部成活，创面Ⅰ期愈合；1 例远端小部分表浅皮肤坏死，局部换药 1 周后创面经植皮愈合。供区植皮成活，创面Ⅰ期愈合。17 例患者获随访，随访时间 5～24 个月，平均 16 个月。皮瓣颜色、质地较好，蒂部略臃肿。踝部及足部运动功能基本正常。 结论 小腿后侧宽蒂双动力皮瓣血管恒定、血供可靠、静脉回流充分，修复范围大，术后成活率高，是修复前足皮肤软组织缺损的良好选择之一。

Objective To investigate the effectiveness of wide fascial and doubly vascularized pedicle posterior cnemis flap in repair of the soft tissue defect of forefoot. Methods Between March 2011 and March 2017, 18 cases with severe soft tissue defects of forefeet were repaired with the wide fascial and doubly vascularized pedicle posterior cnemis flaps. There were 13 males and 5 females with an average age of 33 years (range, 11-49 years). Of 18 cases, the defects were caused by trauma in 16 cases with an average disease duration of 15 hours (range, 3-72 hours), by infection after correction of spastic clubfoot in 1 case, and by infection after open fracture fixation in 1 case. The defects were on the planta of forefoot in 11 cases and on the dorsum of forefoot in 7 cases. The size of soft tissue defects ranged from 6 cm×4 cm to 15 cm×9 cm. All defects combined with the bone, joint, and tendon exposures and 4 defects combined with fractures. The size of flaps ranged from 8 cm×5 cm to 17 cm×10 cm. All wounds of donor sites were repaired by skin grafting. Results The operation time was 100-190 minutes (mean, 140 minutes). Seventeen flaps survived and wounds healed by first intention. One flap had partial necrosis and cured after dressing change. Seventeen cases were followed up 5-24 months (mean, 16 months). Both the color and texture of the flaps were satisfactory. But the pedicles of flaps were swollen. The functions of foot and ankle returned to normal. Conclusion The wide fascial and doubly vascularized pedicle posterior cnemis flap has reliable blood supply and sufficient venous reflux to ensure its survive, which can be used to repair severe soft tissue defect of forefoot.

关键词: 小腿后侧皮瓣; 软组织缺损; 创面修复; 前足

Key words: Posterior cnemis flap; soft tissue defect; wound repair; forefoot

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