超长小腿内侧胫后动脉穿支逆行神经筋膜皮瓣修复足底软组织缺损

Long medial lower leg posterior tibial artery perforator with retrograde nerve fascial flap in repairing plantar soft tissue defect

目的探讨超长小腿内侧胫后动脉穿支和带神经筋膜皮瓣的血供特点及修复足底皮肤软组织缺损的手术方法及临床应用。方法以胫后动脉内踝上发出的皮动脉穿支为筋膜皮瓣转轴点,在小腿内侧设计超长的筋膜蒂皮瓣,皮瓣大小范围5.0cm×10.5cm～25.0cm×6.0cm。转移修复足踝部、足底远端皮肤软组织缺损。结果临床应用8例筋膜皮瓣长度均在16cm以上。结果术后8例皮瓣均成活,创面修复效果好,随访6～12个月,伤肢外形及功能恢复满意,皮瓣感觉获得一定程度恢复,足底负重行走及耐磨功能正常。结论以内踝上4.0～7.0cm处胫后动脉较粗大的筋膜蒂穿支血管,切取位于小腿内侧逆行筋膜皮瓣,距离长,面积大,血供可靠,切取便利,不损伤主要血管,成活率高。可修复较长距离的足底、足背皮肤软组织缺损,是修复足底皮肤软组织缺损的理想皮瓣。

Objective To investigate the blood supply of long medial caff posterior tibial artery perforator with nerve fascia flap and evaluate the flap in surgical methods and clinical application. Methods Set the cutaneous artery perforator on posterior tibial artery medial malleolus as rotating point, design a long fascia flap size range of 5.0 cm× 10.5 cm - 6.0 cm ×25.0cm in medial lower leg which is transformed to repair skin soft tissue defect of distal foot or ankle. Results Fasciocutaneous flap in 8 clinical cases of clinical application were more than 1 6 cm in length and results 8 cases of flap survived,all healing effect were better, Follow - up for 6 to 12 months, the injured limb appearance and the function were satisfactory. To some extent ： the flap restore sensation. Walking and weight - bearing function of the affected foot were normal. Conclusion Posterior tibial artery at the medial malleolus on 4 - 7cm larger cutaneous pedicle where it can be cut off the medial retrograde fasciocutaneous flap, long distance, large area, blood supply stable, facilitate, high survival rate and not to damage the main blood vessels. So long medial lower leg posterior tibial artery perforator with retrograde nerve fascial flap is a ideal flap in repairing long distance foot, dorsal skin soft tissue defect.