拇趾腓侧皮瓣在前足微小创面的应用

Application of fibular side flap of the hallux in repairing minor-size tissue defect of forefoot

目的探讨采用拇趾腓侧皮瓣修复前足微小面积皮肤缺损的疗效。方法回顾性分析2003年9月至2012年6月，采用拇趾腓侧皮瓣顺行转移修复12例前足微小面积皮肤缺损患者资料，男9例，女3例；年龄19-55岁，平均27岁；左侧4例，右侧8例；拇趾背侧3例，跖侧9例。创面类型：外伤4例，肿瘤4例，溃疡2例，瘢痕2例。皮肤缺损面积：1．3cm-0．5cm-2．5cm-2．0cm，切取皮瓣面积：1．5cm-0．8cm-3．0cm-1．5cm。设计的拇趾腓侧皮瓣宽度均〈1．5cm，皮瓣带躅趾腓侧趾动脉和趾神经。皮肤缺损均一期修复。皮瓣供区直接缝合。术后从皮瓣愈合、皮瓣感觉、皮瓣形态、供区瘢痕、负重行走感受五个方面对术后疗效进行满意度评价。结果12例皮瓣全部成活，无一例发生皮缘坏死、感染及血管危象。伤口均一期愈合。9例患者获得随访，随访时间3-96个月，平均12个月。末次随访时皮瓣质地柔软，皮肤颜色正常，无磨损及破溃，无须二期整形；皮瓣感觉正常，两点辨别觉为4-10mm。皮瓣供区切口均愈合，瘢痕隐蔽，未影响患者行走及负重功能。术后患者均对疗效表示满意。结论坶趾腓侧皮瓣顺行转移修复前足微小面积皮肤缺损，具有皮瓣耐磨、有神经支配、皮瓣感觉正常、解剖位置恒定、供区隐蔽、能恢复正常的行走和负重功能等优点，是修复足趾及前足跖底负重区微小面积皮肤缺损的好方法。

Objective To explore the curative effect of the treatment for minor-size tissue defect of forefoot by pedicle fibular side flap of the hallux. Methods The data of 12 patients with minor-size tissue defect of forefoot was retrospectively analyzed who were repaired with fibular side flap of the hallux from September 2003 to June 2012. There were 9 males and 3 females, with an average of 27 years （range, 19-55 years）. Among them, 4 injured on the left, 8 on the right side; 3 on the dorsal side and 9 on the plantar. There were 4 cases of traumatic wound, 4 of tumor, 2 of ulcer, and 2 of scar. Sizes of tissue defect were 1.3 cm×0.5 cm-2.5 cm×2.0 cm, the minimal flap size was 1.5 cru×0.8 cm, and the maximal flap size was 3.0 cm×1.5 cm. All flaps were elevated with fibular side artery and nerve of the hallux, and with width less than 1.5 cm, so wound of donor site could be sutured directly. The postoperative curative effect was assessed from five respects including flap healing, the sensation of the flaps, the flap appearance, the scar and weight- bearing walking. Results This kind of flap all survived successfully in the 12 cases, with satisfying cosmet- ic effect and sensory, without skin necrosis and blood vessel crisis. Nine patients were followed up for 3-96 months （average, 12 months）. The flaps were covered with soft and intact normal colored skin, no abrasion or wearing out happened and no subsequent reshaping was needed in the last follow-up. The minor-sized donor site wound could be sutured up directly. Since donor site was selected from non-weight-bearing area, walking and weight-bearing function of the patients were nearly unaffected at all. Sensory of the flaps were normal, with two-point discrimination ranging between 4-10 mm. Conclusion Due to the advantages of thinness, nerve nourishing, constant anatomical position and hidden position of donor site, anterograde fibular side flap of the hallux can be an ideal choice in repairing minor-size tissue defect of forefoot.