腓动脉终末穿支外踝上皮瓣修复足跟外侧创面

Repair of lateral calcaneal wound with the lateral supramalleolar flap pedicled with the end perforator of peroneal artery

目的探讨以腓动脉终末穿支为蒂逆行外踝上皮瓣修复足跟外侧软组织缺损的方法及效果。方法2015年5月至2018年2月,采用以腓动脉终末穿支逆行外踝上皮瓣修复严重创伤导致的足跟外侧软组织缺损共16例,所有创面一期先行扩创、VSD处理控制感染,合并有跟骨慢性骨感染者,行病灶扩大切除后形成的骨缺损暂时用抗生素骨水泥填充。足跟外侧软组织缺损面积为3.0 cm×2.0 cm^8.0 cm×5.0 cm,皮瓣切取面积为3.5 cm×2.5 cm^8.5 cm×5.5 cm。皮瓣供区拉拢缝合缩小创面后,采用植皮修复。跟骨慢性骨感染患者术后6~8周诱导膜形成后行骨水泥取出、自体骨移植术。术后均获随访,其中7例为门诊随访,9例为电话随访。结果16例皮瓣均顺利成活,供、受区伤口均一期愈合。术后随访3~13个月,皮瓣外形良好,不臃肿,色泽与足跟皮肤相似,局部无色素沉着。踝关节屈、伸活动无受限。4例跟骨慢性骨髓炎患者二期植骨后骨折愈合良好,平均愈合时间为8.5个月。结论采用以腓动脉终末穿支逆行外踝上皮瓣修复足跟外侧软组织缺损,手术方法简单,皮瓣血供可靠,是一种修复足跟外侧软组织缺损的理想方法。

Objective To explore the method and effect of repairing the soft tissue defect of the lateral heel with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery.Methods From May,2015 to February,2018,16 cases of lateral calcaneal soft tissue defect were repaired with the retrograde lateral supramalleolar flap pedicled with the end perforator of peroneal artery.All wounds were treated with one-stage dilatation and VSD to control infection.In cases of chronic calcaneal bone infection,the bone defect formed after extensive resection of infected bone was temporarily filled with antibiotic bone cement.The area of soft tissue defect on the lateral heel was 3.0 cm×2.0 cm-8.0 cm×5.0 cm,and the area of flaps was 3.5 cm×2.5 cm-8.5 cm×5.5 cm.The small donor area of the flap was sutured directly,and the larger area was repaired by skin grafting.Patients with chronic calcaneal bone infection underwent bone cement removal and autogenous bone transplantation after inducing membrane formation 6 to 8 weeks after flap transplantation.All cases were followed-up,including 7 cases outpatient follow-up and 9 telephone follow-up.Results All the 16 flaps survived smoothly.The donor and recipient areas of the flaps healed primarily.All cases were followed-up for 3 to 13 months.The flaps had good shape,no swelling,similar color to heel skin and no pigmentation.Ankle flexion and extension were not restricted.Four cases with chronic osteomyelitis of calcaneus healed well after second-stage bone grafting,with an average healing time of 8.5 months.Conclusion The retrograde lateral supramalleolar flap with the end perforator of peroneal artery is an ideal method for repairing the soft tissue defect on the lateral heel with simple operation and reliable blood supply.