逆行腓动脉穿支筋膜蒂皮瓣和逆行胫后动脉穿支筋膜蒂皮瓣的效果比较

Distally-based perforator-plus fasciocutaneous flap：a comparison between peroneal and tibial perforating branch

[目的]比较逆行腓动脉穿支筋膜蒂皮瓣和逆行胫后动脉穿支筋膜蒂皮瓣的临床效果。[方法]回顾分析本院2006年1月-2014年6月收治且实施逆行筋膜皮瓣治疗的93例小腿下段和足踝部皮肤软组织缺损患者的临床资料,依据治疗方式分为腓动脉组（54例）和胫后动脉组（39例）。对两组皮瓣成活率、功能及并发症情况进行比较。[结果]腓动脉组皮瓣一期成活率为88.9%,显著性高于胫后动脉组的71.8%（P〈0.05）。腓动脉组皮瓣功能指标（疼痛、活动限制、穿鞋限制、功能恢复满意度）评分与胫后动脉组比较无明显差异（P〉0.05）。腓动脉组增生性瘢痕、瘙痒、色素沉着并发症率分别为20.4%、22.2%、25.9%,均显著低于胫后动脉组的（41.0%、46.2%、51.3%）（P〈0.05）。[结论]逆行腓动脉穿支筋膜蒂皮瓣与逆行胫后动脉穿支筋膜蒂皮瓣可有效修复治疗小腿下段和足踝部皮肤软组织缺损,其中逆行腓动脉穿支筋膜蒂皮瓣的一期成活率高、并发症少。

[Objective]To compare the clinical efficacy of distally-based perforator-plus fasciocutaneous flap based on peroneal and tibial perforating branches.[Method]Ninty-three cases of patients with reconstruction of the distal lower leg,ankle and foot in our hospital from January 2006 to June 2014 were retrospectively analyzed.Patients were divided into peroneal artery group（ 54 cases） and posterior tibial artery group（ 39 cases） based on the treatment methods.The flap survival,function,and complications of two groups were compared.All data were statistically analyzed using SPSS16.0 software.[Result]The one stage flap survival rate of peroneal artery group was 88.9%,which was significantly higher than that of posterior tibial artery group（ 71.8%）（ P〈0.05）.The flap function parameters（ pain,activity limitations,restrictions for shoes,functional recovery satisfaction） of peroneal artery group had no significantly difference compared with that of posterior tibial artery group（ P〈0.05）.The hypertrophic scars,itching,pigmentation complication rates of peroneal artery group were 20.4%,22.2%,25.9%,which were significantly lower than those in posterior tibial artery group（ 41.0%,46.2%,51.3%）（ P〈0.05）.[Conclusion]Both the distally-based peroneal artery perforator-plus fasciocutaneous flap and posterior tibial artery perforator-plus fasciocutaneous flap can effectively repair defect of the distal lower leg,ankle and foot.Whereas the one stage flap survival rate of peroneal artery technique is higher and the complication rate is lower.