游离腓动脉穿支筋膜瓣修复手部皮肤缺损

Free adipofascial flap from peroneal perforator artery for repair of hand skin defects

目的探讨应用游离腓动脉穿支筋膜瓣修复手部软组织缺损，减少供区损伤的方法和临床效果。方法2007年12月至2009年10月，对6例手部皮肤缺损患者，应用游离腓动脉肌皮穿支筋膜瓣进行修复，切取面积为5．0cm×4．5cm～10．0cm×7．0cm，以肌皮穿支为蒂。动脉血管蒂与受区血管采用端侧吻合，受区筋膜瓣行断层植皮覆盖。供区创面直接缝合。结果术后6例筋膜瓣全部存活；术后7d，筋膜表面植皮成活大于90％4例，80％2例。随访时间为3～12个月，1例皮瓣臃肿，术后3个月行皮瓣修整术；5例皮瓣略臃肿，外观满意。小腿供区仅留线条瘢痕。结论腓动脉穿支筋膜瓣是在腓动脉穿支皮瓣基础上的改良，目的是减少供区创伤，改善小腿外观。筋膜瓣本身可以填充组织缺损，为功能重建提供条件。

Objective To explore the surgical technique and clinical outcomes of applying the freeadipofaseial flap nourished by musouloeutaneous pefforators of the peroncal artery to repair soft tissue defects of the hand. Methods Six eases of skin defects in the hand were treated from December 2007 to October 2009 with free peroncal artery perforator fascial flap. The size of the raised flaps ranged from 5.0 cm × 4.5 cm to 10 cm ×7 cm. In moot eases the museulocutaneous branch was chosen as the vascular pediele for anastomoois. The blood vessels were anastomooed in an end-to-side fashion. The transferred fascial flap was covered with split thickness skin graft, while the donor site was closed directly. Results All the adipofascial flaps survived uneventfully. The skin graft over the fascial flap showed over 90% survival in 4 eases and 80% survival in 2 cases after 7 days. Follow-up time ranged from 3 to 12 months. Flap bulkiness was seen in one case which underwent debulking procedure 3 months later. The appearance of other 5 cases was satisfactory with only slight flap bulkiness. Only a linear sear was left at the calf donor site. Conclusion The free adipofaseial flap was a modification of peroneal perforator flaps to minimize morbidity and improve cosmoses of the donor site. The adipofasoial flap ean also fill the void caused by soft tissue defects and provide better condition for functional reeonstruction.