胫后动脉穿支供血的隐神经营养血管逆行皮瓣的临床应用

Clinical application of reverse saphenous neuro-veno.fasciocutaneous flap pedicled with posterior tibial artery perforator

目的探讨胫后动脉穿支供血的隐神经营养血管逆行皮瓣的设计与临床应用。方法以胫后动脉发出的穿支为血管蒂，沿隐神经营养血管轴线设计、切取皮瓣，逆行转位、覆盖创面。结果自2005年12月至2011年12月，应用带胫后动脉穿支供血的隐神经营养血管逆行皮瓣修复踝、足跟、足背创面24例，21例皮瓣完全成活，创面I期愈合，3例皮瓣远端约2cm坏死，经换药及手术植皮创面愈合。随访6—18个月，皮瓣外形及功能良好。结论带胫后动脉穿支供血的隐神经营养血管逆行皮瓣不损害主干动脉、供区破坏小、操作简单、易成活、受区覆盖好，是修复踝、足跟、足背组织缺损的理想方法。

Objective To investigate the design and the clinical application of reverse saphenous neuro- veno-fasciocutaneous flap pedicled with posterior tibial artery perforator. Methods The perforator raised from posterior tibial artery was selected as the pedicle, and the flap was designed and harvested along the saphenous vessel to transverse reversely and repair the wound. Results From December 2005 to Decem- ber 2011, totally 24 patients with wound on ankle, heel or acrotarsium were repaired by the methods mentioned above. Twenty-one cases healed primarily with flaps survived totally, and 3 cases got 2 cm flap necrosis on dis- tal, which were cured after changing dressing and skin graft. Follow-up was performed for 6 to 18 months, and all flaps received satisfactory outcome and function. Conclusion It is an optimal approach for the repair of wound on ankle, heel and aerotarsium by reverse saphenous neuro-veno-fasciocutaneous flap pedicled with pos- terior tibial artery perforator, with such advantages as non injury on main artery, few damage on donor site, eas- y performing, easy to survive, and good recover of recipient site.