足跖背动脉穿支逆行皮瓣修复前足软组织缺损43例

Forefoot reconstruction in application of the reverse dorsal metatarsal artery perforator flap： 43 cases report

目的探讨应用足跖背动脉穿支逆行皮瓣修复前足软组织缺损的临床效果。方法自2008年1月至2016年3月，对前足各种病因所致软组织缺损的43例．均采用以足背作为组织供区、以跖背动脉穿支为供血动脉、以趾蹼间吻合支为血管蒂来设计逆行岛状皮瓣进行修复．皮瓣切取面积2．0cm×4．0cm～6．0cm×8．0cm。其中第1跖背动脉穿支皮瓣27例．第2跖背动脉穿支皮瓣8例．第3跖背动脉穿支皮瓣4例。第4跖背动脉穿支皮瓣4例。术后定期进行随访。结果皮瓣全部成活，但其中有6例出现静脉危象。4例经处理后好转．2例出现尖端表皮坏死，经换药后痊愈。随访时间3～24个月，平均8．2个月。皮瓣全部成活，质地良好，有弹性，可耐磨，外形满意，行走功能正常。结论足跖背动脉穿支逆行皮瓣是修复前足中、小面积软组织缺损的理想方法。

Objective To discuss the clinical apphcation of reverse dorsal metatarsal artery perforator flap for reconstruction of forefoot soft tissue defects. Methods Since January, 2008 to March, 2016, 43 patients with fore- foot soft tissue defect due to various causes were reconstructed with the flap based on dorsal metatarsal artery perfora- tor. Dorsal pedis was used as a donor site with dorsal metatarsal artery perforator as the donor artery. The flap size var- ied from 2.0 cm × 4.0 cm to 6.0 cm × 8.0 cm. Among them, 27, 8, 4 and 4 cases were reconstructed with flap based on first, second, third and fourth dorsal metatarsal artery perforator flap respectively. Results All the patients were fol- lowed-up which ranged from 3 months to 24 months. Six flaps suffered from post operative venous congestion. Out of 6, 5 survived with early emergency management while the remaining 2 suffered epidermal necrosis which survived with regular dressing change. Eventually, all the flaps survived. They had good texture and they were elastic, good-looking and very wear-resisting. Walking function was normal. Conclusion Reverse dorsal metatarsal artery perforator flap is an ideal choice in reconstruction of small to medium sized soft tissue defects of forefoot.