远端筋膜蒂第一跖背动脉皮瓣修复趾皮肤缺损

Distal Fascia Pedicled Flap with First Dorsal Metatarsal Artery for Repair the Skin Defects in Hallux

目的探讨远端筋膜蒂第一跖背动脉皮瓣修复蹰趾皮肤缺损的临床效果。方法回顾性分析2008年10月～2013年10月采用远端筋膜蒂第一跖背动脉皮瓣修复躅趾皮肤缺损患者9例，供区行中厚皮片移植。结果9例患者均获得随访，随访时间平均6（3～12）个月。皮瓣全部成活，皮瓣颜色、质地、厚薄与受区皮肤相近。1例皮瓣少许皮肤坏死，经换药3周后Ⅱ期愈合。供区植皮均Ⅰ期愈合。两点辨别觉为6～13mm，患者行走正常，皮瓣及供区植皮处皮肤无破溃。患者对外观、功能满意。结论相较于传统第一跖背动脉皮瓣，远端筋膜蒂第一跖背动脉皮瓣血管蒂长，转移覆盖范围增大，皮瓣血供更有保障，供区影响小，术后外形良好，是修复躅趾皮肤缺损的一种较好的方法。

Objective To explore the clinical effect of distal fascia pedicled flap with first dorsal metatarsal artery in repairing of the skin defects in hallux. Methods From October 2008 to October 2013, a total of 9 cases with skirt defect of hallux were repaired by the distal fascia pedicled flap with first dorsal metatarsal artery. The middle thickness skin transplantation was carried out in donor site. Results All the 9 cases were followed up for 3 to 12 months With an average of 6 months. All flaps were survived with similar appearance, texture and thickness of recipient site. Slight cutaneous necrosis was found in one case and cured by 3-week change dressing. All skin grafting of donor site was cured in stage Ⅰ. The two point discrimination was 6 to 13 mm. All patients recovered to normal locomotion and satisfied appearance and function. Conclusions The distal fascia pedicled flap with first dorsal metatarsal artery is an ideal method for repairing the skin defects in hallux. Compare to traditional first dorsal metatarsal flap, it has many advantages such as long vascular pedicles, large rotate and coverage area, little influence on the donor sites and satisfactory appearance.