远端蒂皮瓣或逆行岛状皮瓣转移术蒂部减张皮瓣的设计与应用

Design and application of tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap

目的探讨在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣的可行性和临床应用效果。方法临床应用胫后动脉内踝上皮支逆行岛状皮瓣修复9例，胫后动脉小腿内侧穿支远端蒂皮瓣修复2例，腓动脉外踝上皮穿支逆行岛状皮瓣修复8例，腓浅神经营养血管逆行岛状皮瓣修复4例，远端蒂腓肠神经营养血管皮瓣修复3例，掌背筋膜蒂逆行岛状皮瓣修复2例。蒂部减张瓣呈梭形或圆形，面积为1．0cm×1．0cm～5．0cm×3．5cm。结果28例皮瓣术后血运良好，无肿胀、淤血，全部成活，随访皮瓣质地良好，外形美观，供区均一期愈合，疗效满意。结论在远端蒂皮瓣或逆行岛状皮瓣蒂部设计减张皮瓣是可行的，可有效地防止蒂部血管受压或血管网破坏而影响皮瓣的血运，是一种可靠的预防远端蒂皮瓣或逆行岛状皮瓣血供障碍的新方法。

Objective To explore the feasibility and clinical results of the tension skin flap of the pedicle of distally based skin flap or reverse-flow island flap. Methods Nine cases were repaired using reversed island flap pedicled with cutaneous branches of medial supramalleolar of posterior tibial artery in clinic, 2 cases using distally based skin flap pedicled with the medial perforator of the posterior tibial artery, 8 cases using reversalisland flap of peroneal artery lateral mulleolus skin perfarator 4 cases using reversed island flap pedicled with superficial peroneal nerve and its nutrient vessels, 3 cases using distally based sural neurocutaneous flap, and 2 cases using reversed island flap pedicled with dorsal fascia of hand. The area of the tension flap was 1.0 cm x 1.0 cm to 5.0 cm x 3.5 cm. Results All the flaps completely survived. On the postoperative years follow-up, the texture of the flap was excellent, and primary healing was obtained at the donor site. Conclusion It＇s effective to design at the pedicle of the distally based flap or reversed island flap a tension skin flap, which can prevent the vessels from compressing or destroying.