腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤

APPLICATION OF FREE BILOBED MEDIAL SURAL ARTERY PERFORATOR FLAP FOR REPAIRING PENETRATING WOUND OF FOOT

目的探讨腓肠内侧动脉穿支双叶游离皮瓣修复足部贯通伤的疗效。方法 2012年4月-2014年10月,收治7例足部贯通伤患者。男5例,女2例;年龄21~43岁,平均31.5岁。致伤原因:压砸伤4例,钝器穿刺伤2例,火器伤1例。左足4例,右足3例。纵向贯通5例,横向贯通2例。创面范围4 cm×3 cm^9 cm×7 cm。受伤至入院时间0.5~5.5 h,平均3.2 h。采用大小为5 cm×4 cm^10 cm×8 cm的腓肠内侧动脉穿支双叶皮瓣游离移植同时修复两侧创面,并重建皮瓣感觉。供区直接缝合或植皮修复。结果术后1例发生皮瓣远端小面积坏死,经换药后成活;1例发生创面感染,经再次扩创引流后延期愈合;余5例皮瓣顺利成活,创面Ⅰ期愈合。供区植皮均顺利成活,切口均Ⅰ期愈合。术后患者均获随访,随访时间7~24个月,平均12.5个月。皮瓣质地柔软,颜色与周围正常皮肤相似,穿鞋及负重均未受影响,无破溃。供区瘢痕平坦,对功能无明显影响。末次随访时,参照英国医学研究会(BMRC)感觉功能评定标准对皮瓣感觉进行评定,其中S_2 1例,S_3 4例,S_(3+)2例。参照美国矫形足踝协会(AOFAS)踝、足功能评分系统评定患足踝功能,AOFAS评分87~97分,平均93.6分;其中优6例,良1例。结论腓肠内侧动脉穿支双叶游离皮瓣能同时修复足部贯通伤两侧创面,重建皮瓣感觉,是修复足部贯通伤的一种较好术式。

Objective To explore the effectiveness of the free bilobed medial sural artery perforator （BMSAP） flap to repair penetrating wound of the foot. Methods Between April 2012 and October 2014, 7 cases of foot penetrating wounds were treated with the BMSAP flap. There were 5 males and 2 females, aged from 21 to 43 years （mean, 31.5 years）. The causes of injury included the crush injury （4 cases）, blunt puncture （2 cases）, and firearm injury （1 case）. The wound was located at the left foot in 4 cases and at the right foot in 3 cases. There were longitudinal penetrating injury in 5 cases and transverse penetrating injury in 2 cases. The size of wound ranged from 4 cm×3 cm to 9 cmx7 cm. The interval between injury and admission was 0.5-5.5 hours （mean, 3.2 hours）. The free BMSAP flap of 5 cm×4 cm-10 cm×8 cm in size was used to repair the wounds on both sides and to reconstruct the sensation. The donor site was sutured or repaired with skin graft. Results After operation, 1 case had distal flap necrosis, the flap survived after dressing change; 1 case had wound infection, and delayed healing was obtained after drainage; and the flap survived completely, and primary healing was obtained in the other 5 cases. The skin grafts survived and healing of incision by first intention was observed at donor sites. The patients were followed up from 7 to 24 months （mean, 12.5 months）. The flap had soft texture and similar color to normal skin. According to the British Medical Research Council （BMRC） sensory function assessment system, 1 case was rated as S2, 4 cases as S3, and 2 cases as S3＋. The American Orthopaedic Foot and Ankle Society （AOFAS） score was 86-97 （mean, 93.6）; the results were excellent in 6 cases and good in I case. Conclusion The free BMSAP flap is very suitable to repair penetrating wound of the foot. The flap has the advantages of repairing the two wounds at the same time and reconstructing skin sensation as well.