摘要
目的探讨顺行或逆行胫后动脉穿支蒂岛状皮瓣修复内踝及小腿内侧创面的临床效果。方法回顾性分析2011年1月至2013年2月，采用顺行或逆行胫后动脉穿支蒂岛状皮瓣修复13例内踝及小腿内侧创面的患者资料，男8例，女5例；年龄19-65岁，平均32岁。创面均位于内踝及小腿内侧，5例伴有骨、肌腱及血管外露。其中5例胫骨远端骨折伴血管、神经外露者，急诊行骨折内、外固定术及胫后动脉穿支皮瓣修复创面；8例无血管、神经外露者，采用真空封闭引流负压吸引后二期行皮瓣修复手术；7例采用胫后动脉穿支蒂v-Y顺行推进皮瓣，6例采用胫后动脉逆行穿支皮瓣。皮肤缺损面积为1．5cmX2．0cm～9．0cruX5．0cm，切取皮瓣面积为1．5cmX3．0cm～14．0cmX7．0em。顺行皮瓣供区直接缝合，逆行皮瓣供区取腹部全厚皮片植皮修复。结果13例患者术后皮瓣血液循环稳定，无一例发生回流障碍，均于术后2周一期愈合。术后13例患者均获得随访，随访时间6-24个月，平均13个月。皮瓣全部一期成活，蒂部无臃肿及“猫耳”畸形，皮瓣质地柔软，外观满意，颜色与周围皮肤接近。5例合并骨折患者术后3-4个月骨折临床愈合，骨折线基本消失。供区皮肤直接缝合者，术后瘢痕较小；供区游离植皮者，创面平整，无明显瘢痕增生。术后踝关节背伸10^。～25^。，跖屈15^。～45^。；患者均对术后疗效表示满意。结论采用顺行或逆行胫后动脉穿支蒂岛状皮瓣具有不牺牲主干血管的优点，是修复内踝及小腿内侧创面的一种简单、有效的治疗方法。
Objective To investigate the clinical efficiency of repairing ankle and calf wounds by antegrade or retrograde perforating flap of posterior tibial artery. Methods 13 cases with skin defects of ankle and calf wounds were reviewd. The defects were repaired using antegrade or retrograde perforating flap of posterior tibial artery from January 2011 to February 2013, 8 males and 5 females; aged 19 to 65 years old. Wounds were located in the ankle and calf, area which the tibial artery support contu- sioned slightly; defects were associated with exposed bone or tendon, exposed blood vessels. Of the l 3 cases, 5 cases have multiple ankle fracture with blood circulation disorders, internal and external fracture fixation were performed emergency with blood ves- sels and nerves exposed, at the same time emergency line wound repair by posterior tibial artery perforating flap. The other 8 cases have no blood vessels and nerves exposure, and accepted vacuum sealing drainage emergency external fixation and flap surgery. Seven cases accepted V-Y antegrade perforating flap of posterior tibial artery, 6 cases using retrograde tibial artery perforator flap. Whose defects were ranged from 1.5 cmX2.0 cm to 9.0 cmXS.0 cm. Antegrade or retrograde perforating flap of posterior tibial ar-tery with 1.5 cmx3.0 cm to 14.0 cm×7.0 cm was used to repair ankle or lower leg medial defect. Antegrade flap donor site sutured directly, but retrograde flap donor site take full thickness skin graft repair from abdomen. Results Circulations of the all 13 cases were stable, with wound healing well after 2 weeks. The patients were followed up for 6 months to 24 months, average of 13 months. All flap graft survived, pedicle no bloated and ”“cat ear”deformity. Flaps were soft, no bloated appearance; color was con-sistent with normal skin. Fracture line in the 5 patients was disappeared. Bone healing time was 3.0 to 4.0 months. At the direct su-ture skin donor sites, postoperative scar was small; skin graft donor sites had no obvious scar. Postoperative ankle dorsiflexion 10^. to 25^., plantar flexion 15ο to 45ο. Patients were extremely satisfied with the results of repair. Conclusion Using antegrade or ret- rograde posterior tibial artery perforator flap without sacrificing the main vessel, it is a simple and effective method to repair the medial malleolus and calf wounds.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2014年第8期824-830,共7页
Chinese Journal of Orthopaedics
关键词
外科皮瓣
小腿
创伤和损伤
皮肤移植
Surgical flaps
Leg
Wounds and injuries
Skin transplantation
