胫后动脉内踝穿支蒂螺旋桨皮瓣修复足跟后区创面

Propeller flap based on perforating branches of posterior tibial artery at medial malleolus for repairing heel wound

[目的]介绍胫后动脉内踝穿支蒂螺旋桨皮瓣修复足跟后区创面的手术技术与初步临床结果。[方法]2016年3月~2018年9月,应用胫后动脉内踝穿支蒂螺旋桨皮瓣修复足跟后区软组织缺损22例。其中男15例,女7例;年龄21~52岁,平均(33.42±7.24)岁。创面位置位于足跟后区,创面大小:2.5 cm×3 cm^5.7 cm×6.5 cm。通过术前下肢血管造影(CTA)及手持彩色多普勒超声精确定位穿支点位置,术前测量创面大小设计穿支蒂螺旋桨皮瓣大桨和小桨,术中根据设计切取皮瓣,旋转120°~180°修复创面。[结果]术后皮瓣均存活;2例供区部分植皮修复,创面及供区均Ⅰ期愈合。患者均获随访,时间2~18个月,皮瓣外形良好,色泽、质地及弹性佳,无挛缩,供区外观良好。[结论]胫后动脉内踝穿支蒂螺旋桨皮瓣与足跟后区组织相近,内踝穿支位置恒定,皮瓣易于旋转,无需牺牲主要血管,是修复足跟后区中等创面的理想选择之一。

[Objective]To introduce the surgical technique and primary clinical outcomes of propeller skin flap based on perforating branches of posterior tibial artery at medial malleolus for repairing the heel wound.[Methods]From March 2016 to September 2018,22 patients underwent repairing soft tissue defect in the heel region with propeller skin flap based on perforating branches of posterior tibial artery at medial malleolus.Among them,there were 15 males and 7 females,aged from 21 to 52 years.The wounds located at heel area with size of 2.5 cm×3 cm^5.7 cm×6.5 cm.The computer tomographic angiography(CTA)and hand-held color Doppler ultrasound for the lower extremity were applied to locate the penetrating branches accurately.Preoperative measurements of wound size were carried out to design the perforating branches pedicled propeller skin flap.During the operation,the flap was cut and freed according to the preoperative design,then rotated 120~180 degrees to repair the wound.[Results]All the patients got flaps survived after operation with local free skin grafting in 2 patients,and the wound and donor area healed by first intention.All patients were followed up for 2 to 18 months.The flaps had good appearance,color,texture and elasticity,additionally good appearance of donor site without any contracture.[Conclusion]Propeller skin flap pedicled by perforating branches of posterior tibial artery at medial malleolus with advantages of similar texture to the tissue of posterior heel area,constant anatomic position of perforating branches at the medial malleolus,easy rotation without sacrificing the main vessels,is one of the ideal options for repairing the medial wound on posterior heel area.