胫前动脉前踝上穿支皮瓣修复足远端毁损伴皮肤软组织缺损

Anterior tibial artery perforator flap for repairing distal foot damage with skin and soft tissue defects

目的探讨采用胫前动脉前踝上穿支皮瓣局部转移修复足远端毁损伴皮肤软组织缺损的治疗效果。方法2013年1月至2016年10月,唐山市第二医院手二科收治足部远端皮肤软组织缺损患者9例,男6例,女3例,均为足远端严重毁损合并皮肤软组织缺损、肌腱及骨质外露,缺损范围:5 cm×3 cm^9 cm×6 cm。采用同侧胫前动脉前踝上穿支皮瓣修复,供区直接缝合或全厚皮片植皮修复。结果术后9例皮瓣全部成活,无血管危象、淤血、张力性水泡等发生,术中切取皮瓣7 cm×5 cm^11 cm×8 cm,1例出现皮瓣边缘部分坏死,经换药后治愈。术后随访6~34个月,平均18个月,皮瓣柔软,无明显臃肿,外观及功能恢复满意。结论胫前动脉前踝上穿支皮瓣修复足远端皮肤软组织缺损,具有手术操作简单、创伤小、皮瓣成活率高、外观佳等优点,是一种较理想的皮瓣供区。

Objective To investigate the effect of repairing the skin and soft tissue defects of foot with the anterior tibial artery perforator flap.Methods Nine patients received the operation using the anterior tibial artery periosteal perforator flap to repair distal foot lesion with skin and soft tissue defects.There were six males and three females.All cases were the distal foot defects of skin and soft tissue with tendon and bone exposure,including traffic accident injury in 5 cases,crush injury in 3 cases,other causes of injury in 1 case.The defects ranged from 5 cm×3 cm to 9 cm×6 cm.The flaps ranged from 7 cm×5 cm—11 cm×8 cm.The donor sites were repaired with direct suture or full-thickness skin grafts.Results All the flaps were survived,without vascular crisis,congestion and blisters.1 case had partial necrosis of flap margin,which was cured after dressing.All cases were followed up for 6 months to 34 months(mean 18 months).The appearance and function recovery of flaps were satisfactory.Conclusions It is an ideal flap donor site for repairing soft tissue defects of the distal foot with the anterior tibial artery perforator flap,which has the advantages of simple operation,less trauma,high skin flap survival rate and good appearance.