胫前后动脉残端的病理变化及用作游离皮瓣的供血动脉修复小腿软组织缺损

The pathological changes of traumatic anterior and posterior tibial artery stump and the application in repair of soft tissue defect in leg

目的 探讨胫前后动脉残端的病理变化和用做游离皮瓣的供血动脉修复小腿软组织缺损的临床疗效.方法 2007年1月-2017年5月,收治20例小腿软组织缺损患者,均伴有胫前或胫后动脉断裂缺损及不同程度骨肌腱外露.全部采用股前外侧皮瓣游离移植修复.术中游离胫前或胫后动脉残端寻找分支,并于发出分支处的远近端各切取动脉主干做为标本.将胫前或胫后动脉分支近侧的主干与旋股外侧动脉降支吻合,将大隐或小隐静脉与降支伴行静脉吻合.切取的标本分为分支近、远端两组,标本做HE染色,镜下观察血管结构,计算两组管壁完好率,进行 χ2检验比较两组差异.结果分支近端组管壁完好率为100%,远端组为20%,P〈0.05.3例术后皮瓣远端部分坏死,经换药后愈合,其余皮瓣顺利成活.术后随访2~48个月,皮瓣质地柔软,色泽与正常肤色基本一致,患肢可负重,行走自如,无异常步态.结论 胫前、后动脉残端在发出分支处的近端管壁完好,明显优于远端,用其做游离皮瓣的供血动脉移植修复小腿软组织缺损疗效良好.

Objective To explore the pathological changes of traumatic anterior and posterior tibial artery stump and its clinical effect as recipient artery on the repair of soft tissue defect in leg. Methods From January 2007 to May 2017, 20 cases of soft tissue defect in leg combined with anterior or posterior tibial artery rupture and bone tendon exposure were repaired by anterolateral thigh flap transplantation. During the operation, the vascular branch of the stump was searched, specimens were cut from the traumatic anterior or posterior tibial artery. The incision site located near the branch. The proximal end of tibial artery to the branch was anastomosed with descending branch of lateral circumflex femoral artery, the great of small saphenous vein was anastomosed with descending branch satellite. The specimens were divided to two groups, one was proximal to the branch, the other was distal. The specimens were stained by HE method, the vascular structural changes were observed under the microscope, the intact rate difference between two groups was compared using χ2 test. Results The intact rate of proximal group was 100%, the distal group was 20%, P〈0.05. 3 flaps had distal necrosis ,obtained healing by dressing change, all the other flaps survived completely, after the postoperative follow up of 2 to 48 months, the texture was soft, color was similar to the normal. The affected limb could be loaded and walked way back, without any abnormal gait. Conclusion The structure of traumatic artery stump proximal to the branch is good, and is obviously better than distal one. By using it as recipient artery, the clinical effect of free flap transplantation to repair soft tissue defect of leg is good.