隐动脉-胫后动脉穿支岛状皮瓣修复小腿中下段皮肤缺损

The perforators-chain island flap based on the saphenous artery and posterior tibial artery for covering skin defects in middle and distal lower leg

目的探讨应用隐动脉一胫后动脉穿支链岛状皮瓣修复小腿中下段软组织缺损的临床效果。方法2012年4月至2015年2月，对11例小腿中下段皮肤缺损者，采用在多普勒血流仪引导下设计以小腿上段内侧胫后动脉穿支浅出点为旋转点，以胫后动脉穿支浅出点与隐动脉穿出点连线为轴线，切取大腿内侧中下段以隐动脉-胫后动脉穿支链为蒂的岛状皮瓣逆行转移修复，皮瓣面积16．0cm×9．0cm～8．0cm×5．0cm。供区直接缝合。结果术后11例皮瓣完全成活，所有病例均获随访，随访时间3～18个月．平均8个月．皮瓣质地优良，外形与功能恢复满意，皮瓣两点辨别觉6～10mm，供区留有线形瘢痕，膝关节功能无影响。结论隐动脉-胫后动脉穿支链岛状皮瓣血供可靠，不损伤主干血管，皮瓣质地良好，可恢复感觉，供区隐蔽，仅遗留线形瘢痕．是修复小腿中下段软组织缺损的一种较好的方法。

Objective To evaluate the clinical utility of perforators-chain island flap based on the saphenous artery and posterior tibial artery for covering soft tissue defects in middle and distal lower leg. Methods From April, 2012 to February, 2015, the perforators-chain island flaps based on the saphenous artery and posterior tibial artery were used reversely for covering soft tissue defects in middle and distal lower legs in 11 cases. With the assistance of doppler flowmeter, this perforators-chain island flap in the medial aspect of middle and distal thigh was designed to rotate at the perorating point of the posterior tibial artery perforator in the medial proximal erus, with the flap axis connecting the emerging points of perforators from saphenous artery and posterior tihial artery. The size of the flap ranged from 8.0 cm× 5.0 cm to 16.0 cm×9.0 cm. The donor site was closed directly. Results All 11 flaps survived completely. No one lost to follow-up and the follow-up time varied from 3 to 18 months （mean, 8 months）. All flaps were flat with good contour and texture. Satisfactory function and esthetic appearance were achieved in all patients. The twopoint discrimination ranged from 6 to 10 ram. Only leaner scar was observed in the donor site and no disability of the knee joint was recorded during follow-up. Conclusion The perforators-chain island flap based on the saphenous artery and posterior tibial artery provides a practical option for covering soft tissue defects in the middle and distal lower leg. This flap is characteristieed by reliable blood supply without sacrificing main vessels, good contour and texture, satisfactory sensory recovery, conceal donor location, and minimal donor site morbidity with only leaner scar.