游离腓动脉穿支皮瓣修复老年患者前足软组织缺损

Repair of forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients

目的 探讨应用游离腓动脉穿支皮瓣修复老年患者前足软组织缺损的手术方法及临床效果。方法2011年6月至2015年4月，应用游离腓动脉穿支皮瓣修复老年患者前足软组织缺损17例，男10例．女7例；年龄60～74岁，平均65．8岁。致伤原因：交通伤7例，重物压伤9例，电灼伤1例。损伤部位：左足6例，右足11例，合并跖、趾骨骨折9例、肌腱损伤5例。软组织缺损面积：3．0cm×4．0cm—6．3cm×11．2cm。结果本组皮瓣全部成活，伤口均一期愈合，未并发感染，皮瓣供区植皮全部成活。所有病例均获随访，时间8～36个月，平均17．6个月，皮瓣外形良好，略臃肿，质地、色泽接近受区，皮瓣感觉恢复良好。末次随访AOFAS足功能评分为（77．5±13．2），优6例，良9例，可2例。VAS评分平均为（2．6±0．4）。结论游离腓动脉穿支皮瓣具有血管解剖恒定、皮瓣血供可靠、厚薄适中等优点，是修复老年患者前足软组织缺损的有效方法。

Objective To investigate the surgical methods and clinical effect of repairing forefoot soft tissue defects with free peroneal artery perforator flap in elderly patients. Methods From June,：2011 to April,2015, 17 cases of forefoot soft tissue defects repaired with free peroneal artery perforator flap in elderly patients. There were 10 cases of male and female in 7 cases with an average age of 65.8 years old ranging from 60 to 74 years. Causes of injury： traffic accident in 7 cases, heavy crushing in 9 cases, electrical burns in 1 case. Injury part： 6 cases on the left side and 11 cases on the right side. Metatarsus and phalanges fracture in 9 cases, tendon injury in 5 cases. Defect area： 3.0 cm × 4.0 cm-6.3 cm×11.2 cm. Results All flaps survived. All wounds were primary healing. Skin graft survived for the foot flap donor site, and no complicated with infection. All patients were followed up from 8 to 36 months with an average of 17.6 months. The appearance of flaps were good, slight bloated. The texture and color of the flaps were close to the recipient site. Flap feel were good. Accortling to （AOFAS）eriteria system, the AOFAS score of last follow-up was （77.5±13.2）. Excellent in 6 cases, good in 9 cases, fair in 2 cases. VAS score was （2.6±0.4）. Conclusion The free peroneal artery perforator flap with the advantages of vascular anatomy constant, blood supply is reliable, thickness moderate, etc. It is a useful clinical method to repair foretoot soft tissue defects in elderly patients.