穿支皮瓣在小腿和足深度软组织缺损修复中的应用

Clinical application of perforator flaps on the reconstruction of deep soft tissue injury of lower leg and foot

目的 通过回顾性临床研究,分析几种常用的穿支皮瓣在小腿和足部深度创面的应用方法 ,并初步探讨其使用原则.方法 针对10例交通伤患者小腿和足部伴有骨和/或肌腱外露的创面,采用胫后动脉穿支皮瓣（6例）、胫前动脉穿支皮瓣（3例）和股前外侧皮瓣（1例）,通过带蒂皮瓣移植（8例）、带蒂皮下筋膜瓣移植（1例）和游离移植（1例）方式修复缺损.术前常规行血管多普勒检查,明确穿支定位.术中和术后观察皮瓣血运和皮瓣成活质量,以及供区影响.结果 皮瓣最小面积为4.5 cm ×12.0 cm,最大面积为9.0 cm×19.0 cm.7例全部成活,3例皮瓣远端有轻微的静脉回流障碍,经换药后自愈或植皮后愈合.皮瓣质地柔软,厚度、色泽与受区周围组织匹配.供区无肌肉损伤,运动障碍.结论 小腿胫前、胫后血管来源的穿支皮瓣带蒂移植和股前外侧皮瓣游离移植,是修复小腿和足深度缺损的良好方法 ,符合整形外科皮瓣研究和应用的发展方向.

Objective To discuss the application principles of the frequently-used perforator flaps on the reconstruction of deep wound of lower leg and foot based on the retrospective analyses on their clinical use. Methods Totally 10 patients were treated in this study. Posterior tibial artery perforator flaps in 6 cases, anterior tibial artery perforator flap in 1 case and anterolateral thigh flap in 1 case were designed and transplanted with pedieled skin flap （8 cases） , subcutaneous fascia flap （ 1 case） and free transplantion （ 1 case）. The color Doppler blood flow imaging were conventionally used for the location of perforators. The blood supply of flap and the appearance of the donor and recipient sites were analysed. Results The area of the 10 flaps were from 4.5 cm × 12.0 cm to 9.0 cm× 19.0 cm. Seven flaps survived completely except three with small loss in the end of flaps which healed after dressing change. And there were minimal injuries on the donor sites. Conclusion It is an optimal technique of perforator flaps raised from anterior and posterior tibial arteries on the reconstruction of deep soft tissue injury of lower leg and foot in accordance with plastic surgical principles.