足背外侧动脉链岛状皮瓣修复足踝及足跟后创面

The lateral dorsalis pedis chain-linked artery based flap for reconstruction of the defects of the foot,ankle, and posterior heel

目的探讨应用足背外侧动脉链岛状皮瓣修复足踝及足跟后部创面的手术方法及临床效果。方法2013年6月至2016年2月，采用足背外侧动脉链岛状皮瓣修复足踝及足跟后部创面11例，其中7例以外踝前动脉降支为蒂、3例以外踝后动脉跟外侧支为蒂、1例以第4跖背动脉为蒂。皮肤缺损面积为1．5cm×2．0cm～6．0cm×13．0cm，皮瓣切取面积为2em×3em～7cm×15cm。皮瓣供区均取腹部全厚皮片移植修复。结果术后10例患者获得随访，时间2～18个月，平均8个月。皮瓣全部一期成活，质地柔软，颜色与周围皮肤接近。供区植皮区创面平整，无明显瘢痕增生。患者对术后效果均表示满意。结论应用足背外侧动脉链岛状皮瓣具有不牺牲主干血管、切取面积大、皮瓣薄等优点，是修复足踝及足跟后部创面的一种简单、有效的方法。

Objective To introduce the surgical method of lateral dorsalis pedis chain-linked artery based flap for repairing foot, ankle, and posterior heel wounds, and to evaluate its clinical outcome. Methods From June 2013 to February 2016, 11 cases with skin defects of foot, ankle, and posterior heel wounds were reviewed. The defects were repaired using the lateral dorsalis pedis chain-linked artery based flap. The wounds in 7 cases were repaired using the island flap based on the descending branch of the anterior lateral malleolar artery. The wounds in 3 cases were repaired using the island flap based on the lateral caleaneal branch of the posterior lateral malleolar artery. The reversed flap based on the forth metatarsal artery was used in one patient. The wound defects ranged from 1.5 cm ~ 2.0 cm to 6.0 cmx 13.0 em. The area of the flap ranged from 2 em x 3 cm to 7 cm ~ 15 em were used to repair the wound. The donor site was skin grafted with split-thickness skin harvested from the abdomen. Results Circulations of the all 11 cases were stable,with good wound healing after 2 weeks. 10 patients had clinical follow-up. The patients were followed up from 2 months to 18 months,average of 8 months. All flap grafts survived with no bloated menifestion in pedical or ＂cat＇s ear＂ deformity. Flaps were soft. Color was consistent with normal skin. Skin graft donor sites had no obvious scars. Patients were extremely satisfied with the result of repair. Conclusions The use of the lateral dorsalis pedis chain-linked artery based flap has many advantages, such as no sacrifice of the main vessels,extended coverage area and thin flap. It is a simple and effective method to repair wounds of the foot, ankle, and posterior heel.