吻合神经的胫后动脉穿支螺旋桨皮瓣修复足内踝部软组织缺损

Clinical application of posterior tibial artery perforator propeller flap with nerve anastomosis in the repair of soft tissue defects of the foot and ankle

目的探讨采用吻合神经的胫后动脉穿支螺旋桨皮瓣联合负压封闭引流技术修复足踝部软组织缺损的临床疗效。方法自2017年10月至2018年9月,对收治的9例足踝部软组织缺损患者采用吻合神经的胫后动脉穿支蒂螺旋桨皮瓣联合负压封闭引流修复。缺损创面为3.0 cm×4.5 cm^6.5 cm×9.0 cm。设计胫后动脉穿支蒂螺旋桨皮瓣,旋转180°以大桨覆盖受区创面,小桨覆盖供区创面,并将皮瓣近端隐神经与受区周围感觉神经相吻合,恢复皮瓣感觉功能;供区拉拢缝合,继发缺损采用植皮处理,然后使用VSD材料封闭皮瓣及植皮区。结果本组共9例患者,所有皮瓣及植皮区均存活良好,血运佳,无血肿、感染、坏死等并发症发生,且伤口愈合佳,术后2周拆线。随访1~12个月,皮瓣血运及外观均较好,质地与周围皮肤相近,皮瓣感觉有不同程度地恢复,患者较满意。结论采用吻合神经的胫后动脉穿支螺旋桨皮瓣联合负压封闭引流修复足踝部皮肤缺损,具有不损伤主干血管,质地与周围皮肤相近,感觉恢复良好,可减少静脉回流障碍等优点,是修复足内踝部软组织缺损的较好方法。

Objective To explore the clinical efficacy of posterior tibial artery perforator propeller flap with nerve anastomosis combined with vacuum sealing drainage(VSD) in the repair of soft tissue defects of the foot and ankle. Methods From October 2017 to September 2018, 9 patients with soft tissue defects of the foot and ankle were treated by posterior tibial artery perforator propeller flap with nerve anastomosis combined with VSD. The area of defects ranged from 3.0 cm×4.5 cm to 6.5 cm×9.0 cm. The posterior tibial artery perforator pedicle propeller flap was designed. The flap was rotated 180° to cover the wound of recipient site with a large propeller and the wound of donor site with a small propeller. The proximal saphenous nerve of the flap was anastomosed to the sensory nerve around the recipient site, and the sensory function of the flap was restored. The donor site was sutured and the secondary defect was treated with skin grafting. The flap and skin grafting area were then closed by VSD. Results There were 9 patients in this group. All flaps and skin grafting areas were survived well and the blood supply was good. No hematoma, infection, necrosis and other complications occurred. The wounds were healed well. The stitch removal was performed at 2 weeks after surgery. All patients were followed-up from 1 to 12 months, the blood supply and appearance of the flap was good. The texture of the flap was close to the surrounding skin. The sensation of flap had different degrees of recovery. Patients were satisfied with the clinical efficacy. Conclusion The posterior tibial artery perforator propeller flap with nerve anastomosis combined with VSD was a good method to repair the soft tissue defects of the foot and ankle. This method had the advantages of no damage to the main blood vessels, similar texture to the surrounding skin, good sensory recovery and reduction of the obstruction of venous return.