逆行足背动脉蒂跗外侧动脉皮瓣修复前足内侧皮肤软组织缺损

Lateral tarsal artery flap with retrograde dorsal artery pedicle for repairing soft tissue defects of the forefoot

目的探讨逆行足背动脉蒂跗外侧动脉皮瓣修复前足内侧皮肤软组织缺损的手术方法及临床疗效。方法于足背外侧设计以足背动脉为蒂的跗外侧动脉皮瓣,以足背动脉足底穿支为旋转点,逆行移位修复前足内侧创面,将足背外侧皮神经与受区神经残端吻合。供区采用全厚皮片植皮修复。结果术后8例皮瓣均顺利成活,创面Ⅰ期愈合;1例术后第1天因植皮处包扎过紧,出现血管危象,经手术探查后成活;1例皮瓣出现部分皮缘坏死,经换药后皮瓣成活。供区植皮均成活,切口Ⅰ期愈合。本组均获随访6～24个月,平均13个月。皮瓣质地柔软,色泽与周围正常皮肤相似,外观无臃肿,无磨损及破溃,穿鞋无影响,患者步态正常。术后6个月皮瓣两点辨别觉为4～10mm;未吻合神经者皮瓣仅恢复部分保护性感觉。结论逆行足背动脉蒂跗外侧动脉皮瓣厚度适中且耐磨,血管解剖恒定,血管蒂长,管径粗大,血供充分,而且可重建受区皮肤感觉、是修复前足皮肤软组织缺损的良好选择之一。

Objective To explore the operative method and effects of lateral tarsal artery flap with retrograde dorsal artery pedicle in repairing the soft tissue defect of forefoot.Methods Retrograde transposition was applied for repairing medial forefoot wound,and anastomosis was achieved between the lateral dorsal nerve of foot and the nerve stump based on the design of lateral tarsal artery skin pedicled with dorsal artery.The donor site was repaired with full thickness skin graft.Results All the 8 skin flaps survived and the wound healed in the primary stage.Vascular crisis occurred in 1 case due to the extreme bandaging tightness of the skin grafting area on the first postoperatve day,then the skin flap survived after the operation.Partial margin necrosis occurred in the flap in 1 case,and the flap survived after dressing.All the patients were followed up for 6-24 months（average 13 months）.The texture of the survived flaps were soft;the color was similar to the surrounding normal skin;the appearance was not bloated or ruptured.The patients could wear shoes and walk normally.Six months after operation,the distanse sense was between 4-10 mm.For non-anastomosis of nerves,the flap could restore only part of the protective feeling.Conclusion Lateral tarsal artery flap with retrograde dorsal artery pedicle has advantages of suitable thickness,constant vascular anatomy,long vascular pedicle,large caliber,sufficient blood supply and being able to reconstruct the skin feeling in the grafting area.It is a good method to repair soft tissue defect of forefoot skin.