接力逆行腓动脉穿支皮瓣修复足踝部及供瓣区皮肤软组织缺损

Repair of skin and soft tissue defects at ankle and donor site with relaying reversed peronealartery perforator flaps

目的探讨接力逆行腓动脉穿支皮瓣修复足踝部及供瓣区皮肤软组织缺损的治疗效果。方法采用回顾性病例系列研究分析2015年9月-2017年5月收治的23例足踝部皮肤软组织缺损患者临床资料，其中男16例，女7例；年龄18～69岁，平均35岁。足踝部软组织缺损面积为4．0cm×4．0cm-11．0cm×7．0cm。用接力逆行腓动脉穿支皮瓣修复足踝部及供瓣区，先切取腓动脉远段穿支皮瓣修复足踝部软组织缺损，用腓动脉近段穿支皮瓣修复第一供区，第二供区I期直接缝合。切取腓动脉远段穿支皮瓣及腓动脉近段穿支皮瓣面积分别为6．0cm×5．0cm-14．0cm×8．0cm、7．5cm×4．0cm-14．0cm×5．0cm。观察受区及供区的外形、质地及色泽，采用美国足踝外科协会（AOFAS）评分、Weber两点辨别觉试验评价临床效果。结果患者均获随访6～19个月，平均12个月。术后1例足踝部皮瓣远端皮肤部分坏死，经换药2周愈合，其余皮瓣I期均顺利成活。第一供区无凹陷、破溃；第二供区残留线状瘢痕，不影响整体外观。皮瓣外观平整；质地良好，色泽接近正常。患足AOFAS评分95～98分。皮瓣两点辨别觉8～10mm。结论接力逆行腓动脉穿支皮瓣血供丰富，不牺牲主干血管，在修复足踝部皮肤软组织缺损的同时可以改善第一供区的外观及功能。

Objective To investigate the clinical effect of relaying reversed peroneal artery perforator flaps in repairing skin and soft tissue defects at ankle and donor site. Methods A retrospective ease series study was eondueted on the clinical data of 23 cases of skin and soft tissue defects at ankle and donor site from September 2015 to May 2017. There were 16 males and seven females, with an average age of 35 years （ range, 18-69 years）. The soft tissue defects of ankle ranged from 4.0 cm × 4.0 cm to 11.0 cm ×7.0 cm. The distal perforator flap of the peroneal artery was firstly cut and used to repair the soft tissue defect of the ankle. The proximal perforator flap of the peroneal artery was used to repair the first donor site, and the second donor site was directly sutured at stage I. The perforator flap area ranges of the distal and the proximal perforator of the peroneal artery were 6.0 cm × 5.0 cm to 14.0 cm ×8.0 cm and 7.5 cm ×4.0 cm to 14.0 cm ×5.0 cm, respectively. The shape of recipient area and donor area were observed. The clinical effectscz were evaluated by American Orthopedic Foot and AnkleAssociation （AOFAS） score and Weber two-point discrimination test. Results All patients were followed up for 6-19 months （mean, 12 months）. One case had partial necrosis of distal skin of ankle flap after operation and recovered 2 weeks after dressing change. All the other flaps survived smoothly in the first stage. The first donor site had no sunken area or rupture. Some linear scar remained at the second donor site, which did not affect the overall appearance. The flaps were smooth in appearance, good in texture, and close to normal color. The AOFAS score of the foot was 95-98 points, and the distance of two-point discrimination of flaps ranged from 8 to 10 mm. Conclusions The relaying reversed peroneal artery perforator flap has abundant blood supply, and the operation site is located at the lateral crural region, without sacrificing the main artery. It can improve the appearance and function of the first donor area while repairing the soft tissue defect of the ankle.