游离穿支皮瓣修复足背软组织缺损

Clinical analysis of free perforator flap for repairing soft tissue defects of the dorsum of foot

目的总结分析3种游离穿支皮瓣修复足背软组织缺损的手术效果。方法2015年3月至2017年9月杭州市西溪医院骨科收治36例足背软组织缺损患者,男20例,女16例,年龄21~59岁,平均39.4岁。致伤原因:压砸伤19例,交通伤15例,电灼伤2例。受伤部位:左足19例,右足17例。软组织缺损面积为4.4 cm×6.6 cm^7.1 cm×16.2 cm。所有患者一期行创面清创VSD治疗,足部骨折、脱位常规行克氏针、钢板螺钉固定,同时修复断裂肌腱。二期行皮瓣移植,其中采用游离股前外侧穿支皮瓣修复12例,游离腓肠内侧动脉穿支皮瓣修复15例,游离腓动脉穿支皮瓣修复9例,皮瓣切取面积4.9 cm×7.2 cm^7.9 cm×17.8 cm。结果36例皮瓣全部存活,供、受区伤口均一期愈合,无感染和皮肤坏死。1例股前外侧皮瓣和1例游离腓肠内侧皮瓣术后24 h内出现静脉危象,经拆除部分缝线和清除皮瓣下积血后皮瓣静脉回流正常,顺利成活。所有患者均获随访,时间6~22个月,平均9.8个月,除有2例股前外侧穿支皮瓣因外形臃肿二期行皮瓣整形术外,其余皮瓣外形及穿鞋满意。皮瓣感觉功能恢复良好,两点辨距觉11~16 mm,供区无明显功能障碍。结论游离股前外侧穿支皮瓣、游离腓肠内侧动脉穿支皮瓣及游离腓动脉穿支皮瓣,均适于修复足背软组织缺损,合理选择术式可以获得满意的临床疗效。

Objective This study aims to analyze the outcome of free perforator flap for repairing soft tissue defects on the dorsum of foot. Methods Thirty-six patients with soft tissue defects on the dorsum of foot were treated at a single institution from March 2015 to September 2017. They were 20 males and 16 females, aged from 21 to 59 years old, with the mean age of 39.4 years. The causes of injury include crush injury (n=19), traffic injury (n=15), and electric injury (n=2). The injury site involves left foot (n=19) and right foot (n=17). The defect area of soft tissue was from 4.4 cm ×6.6 cm to 7.1 cm×16.2 cm in size. The vacuum sealing drainage dressing (VSD) was performed for all patients at the first stage of operation. The fracture and dislocated bone were fixed using Kirschner needle and plate screw. The ruptured tendon was repaired at the same time. The flap transplantation was performed at the second stage of operation. Twelve patients were treated with free anterolateral thigh perforator flap, 15 patients were treated with free sural artery perforator flap, and 9 were free peroneal perforator flap. The skin flap was from 4.9 cm× 7.2 cm to 7.9 cm × 17.8 cm in size. Results All 36 flaps survived. The wounds of both donor and recipient area primarily healed, without infection or skin necrosis. The venous crisis occurred in 1 patient of anterolateral thigh flap and 1 patient of free medial sural flap within 24 hours after surgery. Both flaps survived after stitches removed and blood cleaned. All patients were followed up for 6-22 months, with an mean follow-up period of 9.8 months. Except for the swollen anterolateral thigh perforator flap in 2 patients, the other patients were satisfied with the shape of flap and in wearing shoes. The sensation of flap was good, and the two-point discrimination was 11-16 mm. There was no obvious dysfunction occurred in the donor site. Conclusions The free anterolateral thigh perforator flap, free sural artery perforator flap and free peroneal perforator flap are suitable for repairing soft tissue defects on the dorsum of the foot. A reasonable surgical plan can help to obtain satisfactory clinical outcome.