三面会师法切取胫后动脉高位穿支蒂皮瓣修复小腿中下段骨外露

Cutting Posterior tibial artery high perforating flap with three sides method for repairing soft tissue defects of the lower two-thirds of the shank

目的总结胫后动脉高位穿支蒂皮瓣修复小腿中下段软组织缺损的方法及临床疗效。方法 2008年9月～2011年5月,我科共收治25例小腿中下段软组织缺损伴骨外露患者。男19例,女6例,年龄15～61岁,平均36岁。软组织缺损范围2cm×3cm～7cm×14cm;创面采用胫后动脉高位穿支蒂皮瓣修复,供区直接缝合或植皮修复。皮瓣面积为3cm×5cm～9cm×18cm,病程7天至2月。结果术后25例皮瓣全部成活,骨外露创面及供区Ⅰ期愈合。其中2例因切取平面达腘窝平面上2cm,术后皮瓣远端约2cm×3cm表皮青紫,经换药拆线松解蒂部后皮瓣完全存活,18例患者获随访,随访时间6～33月,平均18月。皮瓣色泽、质地及外形良好。随访病例6月后皮瓣恢复保护性感觉。结论胫后动脉高位穿支供血皮瓣血供可靠,操作简便,不损伤肢体主要动脉,供区损害小,是修复小腿中下段软组织缺损的良好皮瓣。

Objective To summarize the method and clinical efficacy of posterior tibial artery high perforating flap repair tissue defects of the lower segment of leg.Methods From September 2008 to May 2011,25 patients of lower leg soft tissue defects with bone exposure were treated in the department.Among of them,there were 19 males,6 females,whose ages are from 15 to 61 years,and the average age is 36 years old.Range of soft tissue defects were 2cm×3cm^7cm×14cm,Wound surface was repaired by high tibial artery branch flap,and the donor sites were closed directly or repaired by skin grafts.The area of flap were from 3cm×5cm to 9cm×18cm,the course of diseases was 7 days to2 months.Results After surgery,all the 25 cases of flaps survived,and exposed bone wound and donor site were healed by first intention.Because of the cut plane reached 2cm above the popliteal plane surface,2 cases had about 2cm×3cm distal skin bruising after surgery,and the pedicle flap was survived completely through dressing and suture removal release.18 patients were followed up for 6 to 33 month,an average of 18 months.Flap＇s color,texture and shape were well.6 months after operation,the flap restored protective sensation.Conclusion The flap blood supply of posterior tibial artery high perforating branches is reliable,easy to operate,does not damage the main body artery,and is a good flap for repairing the lower leg soft tissue defects.