近创面穿支蒂V—Y推进皮瓣修复六种常用皮瓣供区缺损

Adjacent V-Y advanced perforator flap for defect at donor site leaving by six commonly-used flaps

目的总结采用7种近创面穿支蒂V—Y推进皮瓣修复6种常用皮瓣供区的临床经验。方法2007年6月至2014年1月，收治66例手、足部皮肤软组织缺损，创面肌腱或骨外露的患者，分别采用指动脉岛状皮瓣修复15例，拇指指背动脉逆行岛状皮瓣修复9例，掌背动脉逆行岛状皮瓣修复9例，腹部带带皮瓣修复9例，游离股前外侧皮瓣修复15例，腓肠神经逆行岛状皮瓣修复9例。皮瓣供区无法直接拉拢缝合，分别采用近创面指蹼穿支蒂V—Y推进皮瓣、鼻咽窝穿支蒂V—Y推进皮瓣、腕背穿史蒂V—Y推进皮瓣、旋髂深动脉肌皮穿支为带的V—Y推进皮瓣、膝上外侧穿支带V—Y推进皮瓣和股内侧穿支蒂V—Y推进皮瓣、胫后动脉近端穿支V—Y推进皮瓣进行修复。结果本组66例采用6种常用皮瓣完全覆盖创面，术后全部成活，伤口平均愈合时间为15d。近创面穿支蒂V—Y推进皮瓣中，除1例膝上外侧穿支皮瓣近端尖角发生部分坏死，经换药后愈合，其余皮瓣均完全成活，术后随访5～24个月，平均8个月，6种常用皮瓣外观、质地、色泽及弹性良好。皮瓣供区伤口术后线状愈合，搬痕较小，较平整，无明最凹陷，皮瓣质地柔软，外观满意，颜色与周嗣皮肤接近。附近关节活动正常。患者均对术后效果满意。结论近创面穿支蒂V—Y皮瓣推进修复皮瓣供区，不牺牲主干血管、操作简单、术后效果满意，是对传统皮瓣供区修复方法的补充。

Objective To summarize 7 adjacent V-Y advanced perforator flaps for defects at donor sites leaving by six commonly-used flaps. Methods From May 2007 to Jan. 2014, 66 cases with hands and feet skin defects, tendon and bone exposure were treated with reverse island flap（ 15 cases） , thumb dorsal artery island flaps （9 cases） , dorsal metacarpal artery island flaps （9 cases） , abdominal pedicle flaps （9 cases）, free anterolateral thigh flaps （15 cases）, sural nerve retrograde island flaps （9 cases）. The defects at donor sites were covered by adjacent V-Y advanced perforator flaps, including dorsal metaearpal perforator flap, snuffbox perforator flap, dorsal carpal perforator flap, deep iliac circumflex artery musculocutaneous perforating branches flap, outer knee perforator flap, medial thigh perforator flap, proximal posterior tibial artery. Results All the six common flaps survived with average healing period of 15 days. Only one adjacent V-Y advanced outer knee perforator flap underwent partial necrosis at the proximal flap end which healed after dressing. All the other V-Y advanced flaps survived. The patients were followed up for 5 - 24 months （8 on average） with satisfactory flap texture and color both at reconstructed area and donor sites. The adjacent joints had normal movement function. Conclusions Adjacent V-Y advanced perforator flap is an important method for closure of defects at donor sites. It has the advantages of no sacrifice of main artery, satisfactory result and easy performance.