小腿后部巨大腓动脉逆行皮瓣修复足部皮肤软组织缺损

Clinical study on repairing huge soft tissue defect in foot with a extensive reverse peroneal artery flap

目的探讨小腿后部巨大腓动脉逆行皮瓣在修复足部、足远侧半大面积皮肤缺损的应用效果。方法应用小腿后部巨大腓动脉逆行皮瓣修复11例含一个或多个跖趾关节外露的、足部大面积皮肤缺损。皮瓣设计：上界超过腓骨头平面，外侧界达腓骨前缘前2cm，内侧界达腓肠肌内侧缘，下界达内外踝连线，以外踝上1cm为旋转点。手术要点：解剖皮瓣时应将腓动脉在外踝上11—13cm和5～7cm两个肌皮支和（或）皮支带入，并包含腓肠神经、小隐静脉在内的3cm宽筋膜蒂。结果本组11例中10例皮瓣全部成活，1例皮瓣边缘1cm宽区域坏死，经换药处理后愈合。结论应用小腿后部巨大腓动脉逆行皮瓣修复足部大面积皮肤缺损，尤其是含足远侧半的皮肤缺损，皮瓣成活率高，对肢体供血影响小，血管蒂恒定，解剖容易，易于推广。

Objective To introduce the clinical application of a extensive reverse peroneal artery flap in repairing big soft tissue defect in foot, especially in repairing a big defect in distal foot and the exposure of one or more metatarsophalangeal joint. Methods The skin flaps were used in 11 cases to repair the big soft tissue defect in foot, including the distal part of foot. The flap upper boundary may surpass the capitulum fibulae; The lower boundary may reach the back line between external malleolus and internal malleolus; Lateral boundary could overrun anterior margin of fibula about 2 cm; Inboard boundary could get to medial margin of gastrocnemius muscle. In attention： the two branch vessels from peroneal vessel in the site of 11-13 cm and of 5-7 cm above the outer anker would be included in the flap. Results Ten of 11 skin flaps survived satisfactory. A small, marginal portion of one flap in one case presented necrosis. Conclusion The reverse peroneal artery flap is easy to elevate and safety, which is an ideal flap for a huge soft tissue defect in foot, especial in the distal part of foot.