胫前动脉逆行皮瓣重建足部供区

Reverse Anterior Tibial Artery Flap for Reconstruction of Foot Donor Site

目的(?)趾移植、足背皮瓣、第二足趾移植和趾关节移植等进行手再造后,应用同侧小腿胫前逆行皮瓣进行一期足部供区重建。方法总结33例临床病例,详细介绍病例选择、皮瓣设计和手术方法。结果临床应用33例,全部从同一胫前血管系统获得两个串联皮瓣,其中一个游离皮瓣进行手重建,另一个逆行岛状瓣覆盖供区缺损。全部存活,足部供区一期愈合,外观良好,功能满意。结论常规足部供区植皮时常发生伤口延迟愈合、疤痕增生和挛缩,影响供区美观和步态。应用同侧小腿胫前逆行皮瓣重建供区,可使供区获得一期愈合,有良好的外观和功能,降低了并发症发病率,使手术局限在一侧下肢完成。

Objective The foot offers numerous useful options for hand reconstruction. The authors propose a new concept of primary reconstruction of the donor foot using a reverse-flow anterior tibial flap from the same leg. Methods The authors report their experience of 33 cases. The patient selection, flap design and their operative technique were introduced in detail. Results In 33 cases, Two flaps are raised from the same anterior tibial vessel system in continuity as a distal free flap for hand reconstruction and as a proximal reverse-flow pedicled flap to resurface the donor defect. There were no failures. Primary wound healing was achieved in the foot donor site, with acceptable cosmetic and satisfactory function. Conclusions When the donor site is repaired with skin grafts, delayed wound healing, scarring, and contractures often result. Poor appearance of the donor site and altered gait are the main drawbacks of the procedures. This technique allows good flap reconstruction of the foot donor site, reducing morbidity and limiting the operation to the same limb.