不同形式的3种胫后动脉穿支皮瓣修复足踝部创面疗效分析

The clinical curative effect of repairing of the wounds surface of foot and ankle with three different kinds of posterior tibial artery perforator flaps

目的 总结分析3种不同形式的胫后动脉穿支皮瓣转位修复足踝部创面的临床疗效。方法自2008年1月至2014年6月,对26例外伤导致的足踝部皮肤坏死缺损患者,采用3种不同形式的胫后动脉穿支蒂皮瓣转位修复,其中顺行穿支皮瓣5例,螺旋桨穿支皮瓣5例,逆行穿支皮瓣16例,皮瓣切取面积最大为15cm×8cm,最小为6cm×4cm。结果 22例皮瓣全部成活,1例皮瓣坏死经换药2周后行植皮修复,3例皮瓣远端部分坏死经换药等处理后1-2月瘢痕愈合,术后随访3-36个月,平均10个月,25例皮瓣质地柔软,外观满意,1例皮瓣坏死植皮后瘢痕增生明显,5例皮瓣轻度臃肿,足踝部功能未见明显影响。结论 依据足踝部创面特点采用3种不同形式的胫后动脉穿支皮瓣转位修复,临床疗效满意,是一种简单、实用的方法。

Objective To summarize and analyze the clinical curative effectof three different kinds of posterior tibial artery perforator flaps to repair the wounds of foot and ankle. Methods From January 2008 to June 2014,26 patients with skin necrosis and defects of foot and ankle caused by trauma were treated with three different kinds of posterior tibial artery perforator flaps, including anterograde perforator flaps in 5 cases, perforator propeller flaps in 5 cases, and reversed perforator flaps in 16 cases. Above the flaps, the maximum was 15 cm ×8 cm, and the smallest was 6 cm ×4 cm. Results Flaps in 22 cases survived completely, flap in one case that had necrosis which washealed by debridement and skin graft after 2 weeks, and flaps in 3 cases that had marginal necrosis at the distal part of the flaps which scar healing by debridement after one to two months. All patients were followed for 3 to 36 months （mean 10 months）, the texture and appearance of flaps in 25 cases were excellent. In the case with flap necrosis and subsequent skin graft, obvious scar hyperplasia developed. In 5 cases, the flaps were slightly bulky, but the function of the foot and ankle was not obviously influenced. Conclusion According to the characteristics of wound surface of foot and ankle, using three different kinds of posterior tibial artery perforator flapscan obtain satisfactory clinical effect in treating the wounds, which is a simple and practical method.