腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损

The reverse extended peroneal artery perforator flap for soft tissue defects of the ankle and foot

目的探讨应用腓动脉及穿支血管蒂皮瓣逆行转移修复足踝部软组织缺损的手术方法和Ⅰ临床效果。方法2007年4月至2008年2月，收治10例足踝部软组织缺损患者。男7例，女3例；年龄8-52岁，平均34．2岁。致伤原因：车祸伤6例，坠落伤2例，慢性溃疡1例，烫伤1例。在患肢小腿外侧区沿腓动脉轴线设计皮瓣，术中游离包含于皮瓣内的1-3支腓动脉穿支，于腓动脉穿支近端结扎切断腓动脉及静脉，向远端游离至外踝尖上约5cm并以此为旋转点，连同皮瓣向远端逆行转移覆盖足踝软组织缺损区。切取皮瓣范围为10cm×5cm-25cm×15cm，血管蒂长6-17cm。结果术后10例皮瓣全部成活。仅1例皮瓣远端局部回流不畅、浅表坏死，经换药及抗感染治疗后愈合。供区均Ⅰ期愈合。全部病例获5-14个月（平均9．5个月）随访，所有患者皮瓣外形及功能满意，行走正常。结论腓动脉及穿支血管蒂营养皮瓣血管蒂长，蒂部细小易转移而不易受压，血供可靠，切取范围大，皮肤质地良好，用于足踝部皮肤软组织缺损的修复效果满意。

Objective To investigate the operative technique and clinical results of repairing soft tissue defects of the ankle and foot with reverse extended peroneal artery perforator flap. Methods From April 2007 to February 2008, 10 patients, 7 men and 3 women, were treated with this technique, with an average age of 34.2 years （ranged from 8 to 52 years）. The initial wounds were caused by trauma, burn injury and chronic ulcer, with bone and/or tendon exposure. The flap was designed overlying the course of the peroneal artery, which corresponds to the palpable posterior border of the fibula when mapped to the surface. The flap was raised by dividing the peroneal artery and veins proximally and elevating them distally, which covered for the defects of the ankle and foot. The pivot point was placed at the level of the ankle joint distally. Thus the flap was completely isolated on its vascular pedicle, which by design and dissection was long enough permit tension free transposition of the attached soft tissue into the defect. The flaps were designed with the size measuring 10 cm×5 cm to 25 cm×15 cm. The pure vascular pedicle of the flap was 6 cm to 17 cm in length, including the peroneal vessels and one to three perforator branches. Results All 10 flaps survived after surgery. Partial inadequate venous return and distal superficial necrosis happened in only 1 case, which also got secondary healing by changing dressing and anti-infective therapy. The donor sites reached primary healing completely. After following up for 5-14 months, the appearance and function of the flaps were all satisfactory, and no influence to ambulation was found. Conclusion The reverse extended peroneal artery perforator flap supplied by a pure vascular pedicle can be a good alternative for reconstruction of the ankle and foot. The flap, with a long and thin pure vascular pedicle, could provide good texture and contour matching the recipient area.