小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损

Repair of soft tissue defect of foot and ankle in children with leg perforator vascular pedicle flap

目的探讨小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损的临床疗效。方法 2012年5月-2015年1月,采用小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损12例。足踝部软组织缺损面积3.5 cm×5.0 cm～7.0 cm×15.0 cm,均伴有不同程度的肌腱或骨骼外露。带胫后动脉穿支的小腿内侧筋膜蒂皮瓣7例,带腓动脉外踝后上穿支的筋膜蒂皮瓣4例,带胫后动脉穿支的小腿内侧筋膜蒂皮瓣及带腓动脉外踝后上穿支的筋膜蒂皮瓣1例。结果术后12例皮瓣均成活,其中2例皮瓣皮缘远端少许坏死,经换药后愈合;12例获随访,随访时间3～18个月,平均8.9个月;皮瓣血运良好,无臃肿,外形满意,供区愈合良好;患肢功能良好。结论小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损操作简单,疗效可靠,是修复小儿足踝部软组织缺损理想的治疗方法之一。

Objective To investigate the clinical effects of leg perforator pedicel flap to repair soft tissue defect of ankle and foot in children. Methods From May 2012 to January 2014, 12 cases with the soft tissue defect of ankle and foot in children, were repaired by leg perforator pedicel flap. Including medical fascial pedical flap of leg with the posterior tibial artery perforators in 7 cases, external ankle posterosuperior fascia pedicle flap with peroneal artery perforators in 4 cases, medical fascial pedicle flap with the posterior tibial artery perforators and external ankle posterosuperior fascia pedicle flap with peroneal artery perforators in 1 case. The size of ankle and foot soft tissue defect ranged from 3.5 cm×5.0 cm to 7.0 cm×15.0 cm, which different degrees of tendon and bone exposure. Results All flaps survived, with a little necrosis of distal margin of the flap occurred in 2 cases but healed after dressing. All 12 cases were followed up 3-18 months,averaged 8.9 months. The flaps had good appearance and abundant blood supply, the appearance and function recovery were satisfactory. Conclusion Leg perforator pedicel flap is one of the optional method to repaire the soft tissue defect of ankle and foot in children, which was simplicity of operation and reliable clinical efficacy.