摘要
目的探讨穿支血管蒂螺旋桨皮瓣修复足踝部软组织缺损的临床疗效。方法回顾性分析2011年9月至2013年4月，使用穿支血管蒂螺旋桨皮瓣修复并获随访的20例足踝部软组织缺损患者资料，男12例，女8例；年龄5-75岁，平均45岁；5例为轮辐伤致足跟部软组织及跟腱缺损，4例跟骨骨折内固定术后感染致皮肤坏死，2例重物砸伤致足背皮肤缺损，9例车祸伤致足踝部软组织缺损；创面软组织缺损面积2cm×8cm-5cm×20cm；病程7-60d。其中15例采用腓动脉终末支穿支皮瓣、5例采用胫后动脉穿支皮瓣修复足踝部软组织缺损；皮瓣面积为5cmxllcm～7cmx28cm。所有穿支血管术前均在彩色多普勒超声下探查定位，穿支皮瓣的穿支口径0．8-1．0mm。结果超声定位术中穿支血管位置符合率为96．7％（29／30），术后供区直接缝合12例，游离植皮8例。术后24h内1例发生静脉危象，经拆除部分缝线及放血疗法治愈。术后皮瓣均获随访，随访时间为1-18个月，所有皮瓣均存活良好，皮瓣蒂部平整，修复外形满意。结论穿支血管蒂螺旋桨皮瓣操作相对简单，无需吻合血管，安全有效，适用于足踝部软组织缺损的治疗。
Objective To investigatethe clinical efficiency of perforator pedicled propeller flaps for soft tissue coverage of the lower leg and foot defects. Methods Twenty patients with soft tissue defects of the lower leg and foot were reviewed and evaluated retrospectively. The defects were repaired using the perforator pedicled propeller flaps from September 2011 to April 2013. There were 12 males and 8 females, with an average age of 45 years （range, 5-75 years）. Including 5 cases of injuries caused by the spokes and the Achilles heel of soft tissue defects, 4 cases of infection after internal fixation of calcaneal fractures induced skin necrosis, 2 cases of dorsal skin defects caused by heavy injured, 9 cases of foot and ankle soft tissue defects caused by car accidents. The wounds and soft tissue defect area were from 2 cm × 8 cm to 5 cm × 20 cm. The course of disease was from 7 days to 60 days. These flaps included terminal branch of the peroneal artery perforator flap in 15 cases, posterior tibia artery perforator flap in 5 cases. The flap size ranged from 5 cm×11 cm to 7 cm×28 cm. The color Doppler ultrasound were used for the locating of all perforator vessel, the caliber diameter of the perforator artery ranged from 0.8 mm to 1.0 mm. Results The coincidence rate intraoperatively of the the color Doppler ultrasound was 96.7%. The donor sites were sutured directly in 12 cas- es and cured with skin-grafting in 8 cases. One case suffered from venous crisis in 24 hour was cured by the removal of part of the suture and bloodletting. All cases were followed up for 1 month to 18 months, and all flaps survived well and pedicle were smooth with a satisfied appearance. The patient were extremely satisfied with the results for repair. Conclusion The perforator pedicled propeller flap is a simple, without vascular anastomosis, safe and effective. Compared with other pedicle flap, it has more unique advantages for soft tissue coverage of the lower leg and foot defects.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2013年第10期1048-1052,共5页
Chinese Journal of Orthopaedics
关键词
外科皮瓣
足
踝
软组织损伤
Surgical flaps
Foot
Ankle
Soft tissue injuries
