应用小腿穿支皮瓣修复足趾移植后供区的软组织缺损

Application of lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation

目的探讨小腿穿支皮瓣修复足趾移植后供区软组织缺损的治疗效果。方法自2015年12月至2016年12月，我们对15例接受躅甲皮瓣、第一趾腓侧皮瓣及第二趾趾甲皮瓣修复再造手指缺损的患者，采用小腿腓动脉穿支皮瓣或胫后动脉穿支皮瓣修复足趾移植后的供区软组织缺损。结果术后再造指全部存活，足部皮瓣全部存活，随访时间为1～18个月，平均8．6个月，足部供区恢复好，对穿鞋、行走负重无影响。足功能按Sanders等提出的Maryland评分标准评价：优14例，良1例。结论小腿穿支皮瓣修复足趾移植后的供区软组织缺损，不仅能再造出外观和功能兼优的手指，同时能恢复足部供区完整性，足部功能和外观也得到较好的恢复。

Objective To explore the clinical effects of lower leg perforator flap in the treatment of the soft tissue defects in the donor site of toe transplantation. Methods From December 2015 to December 2016, 15 cases of thumb or finger defects were reconstructed by the transplantation of big toe nail flap, the fibula side flap of great toe and second toe wrap-around flap. Simultaneously, the free peroneal artery perforator flap or posterior tibial artery perforator flap was used to repair the soft tissue defects in donor site of toe transplantation. Results All the reconstructed fingers and thumbs survived. All the flaps used to cover donor site of the foot survived. The follow-up time ranged from 1 to 18 months with an average of 8.6 months. The donor site of toe transplantation recovered well without influence on wearing shoes and walking. According to the Maryland foot function scoring system issued by Sanders et al, the results were rated as excellent in 14 cases and good in 1 case. Conclusion Lower leg perforator flap for repair of the soft tissue defects in the donor site of toe transplantation can not only reconstruct the good appearance and function of thumbs and fingers, but also can restore the integrity of donor foot. The function and appearance of the foot are well recovered.