游离腓浅动脉单一穿支皮瓣移植修复前足中小皮肤软组织缺损

Superficial peroneal artery＇s singleness perforator flaps transfer to repair skin and soft defect of forefoot

目的 探讨游离腓浅动脉穿支皮瓣修复前足皮肤软组织缺损的临床疗效.方法 13例前足严重创伤患者,急诊给予骨折内固定、血管神经肌腱修复、皮肤回植及封闭式负压引流（VSD）等处理,7～10d后,待组织坏死界限清晰后,进行腓浅动脉单一穿支皮瓣游离移植术,皮瓣切取面积为3.0cm×5.0cm～6.0cm×10.0cm,供区全厚皮打包加压包扎.结果 12例皮瓣全部成活,1例术后出现动脉血管危象,探查后部分成活,植皮后痊愈.10例获得了1个月～2年随访,无色素沉着及溃疡,外观满意.8例感觉达S 3,4例达S 2.结论 游离腓浅动脉单一穿支皮瓣为穿支皮瓣的延伸,符合现代皮瓣移植的最新观点,具有可一期修薄,不牺牲主干血管,解剖相对简单,供区损伤小,手术在同一区域等优点,是修复前足皮肤软组织缺损较为理想的方法 之一.

Objective To explore the clinical efficacy of free superficial peroneal artery perforator flap for skin and soft tissue defect of forefoot. Methods Thirteen cases of severe forefoot trauma were en- rolled. Among the cases, fracture fixation, repair of blood vessel, nerve and tendon, skin replantation, vacu- um sealing drainage（VSD） and other emergency treatment were performed. After 7-10 days, the boundary of tissue necrosis was clear and the free superficial peroneal artery perforator flaps were transferred. The cutting size ranged from 3.0 cm ×5 cm to 6 cm × 10.0 cm. Full-thickness skin grafts from the donor sites were packed and bandaged. Results Flaps of 12 cases survived. Postoperative vascular crisis occurred in one case. Part of the flap survived after exploration and recovered after VSD suction. Ten cases were fol- lowed up for 4 months to 2 years occurred. The appearance was satisfactory with no pigmentation or ulcera- tion. The sensory recovery achieved $3 in 8 cases and $2 in 4 cases. Conclusion Superficial peroneal ar- tery~ singleness perforator flap is an extension of perforator flap,which fits with the latest modern ideas of flap transplants. The defects can be repaired in one stage without sacrificing the main vessels. Other merits include relatively simple anatomy, small injury of donor area, and the same surgical area. Thus,it is one of the ideal methods to repair forefoot soft tissue defects.