胫后动脉穿支营养皮瓣修复足跟慢性溃疡

Skin flap with a branch of the tibial posterior artery for repairing chronic ulcer of Heel

目的:探讨胫后动脉穿支营养皮瓣修复足跟慢性溃疡的手术方法及临床应用后的效果。方法:以胫后动脉内踝以上发出的皮动脉穿支为筋膜皮瓣转轴点,在伤肢小腿内侧设计恰当长度和宽度的筋膜蒂皮瓣,转移修复足跟慢性溃疡。结果:2009年9月～2013年1月临床应用此方法修复12例足跟慢性溃疡,术后12例皮瓣均成活,随访4个月～2年,平均13个月,可正常行走,皮瓣感觉异常等级评分均值为0.167;供区感觉异常等级评分均值为0.083。皮瓣痛觉等级评分均值为1.250;供区痛觉等级评分均值为1.167。明显感觉功能得到一定程度恢复,且均未再出现皮肤破溃及复发。结论:胫后动脉穿支营养皮瓣修复足跟慢性溃疡,血供有保障,成活率高,损伤小,且术后外形及功能理想,接近于正常足跟组织,值得临床应用推广。

Objective To discuss the surgical method and the effect of posterior tibial artery perforators nutrition flaps repairing heel chronic ulcer. Methods As the arterial perforators of posterior tibial artery fascia as the flap rotation point,design appropriate length and width of flap, transferring to repair heel chronic ulcer. Results Those 12 patients were applied that method to repair chronic ulcer of heel during September 2009 to January 2013. The mean period from surgery to mechanical testing was 13 months （4 to 24）. Flaps survived well in 12 cases and all patients could walk after surgery.The mean score of flap paresthesia level was 0.167;the mean score of feel abnormal level in the supply areas was 0.083. Flap average pain rating score was 1.250;the average pain rating score in the supply areas was 1.167. The body function had a certain degree of recovery and all patients did not reappear skin burst and recurrence. Conclusion This operation had high survival rate,little injury and the shape and function of flap was ideal.So it was worth for clinical promotion.