足底内侧动脉浅支为蒂的游离足内侧穿支皮瓣修复手腕掌部深度软组织缺损

Repair of deep soft tissue defects of wrist and palm with free foot medial perforator flap pedicled with superficial branch of medial plantar artery

目的探讨足底内侧动脉浅支为蒂的游离足内侧穿支皮瓣修复手腕掌部深度软组织缺损的疗效。方法采用足底内侧动脉浅支为蒂的游离足内侧穿支皮瓣修复4例手腕掌部深度软组织缺损患者。皮肤软组织缺损面积4.5 cm×3.5 cm~10.5 cm×4.5 cm,皮瓣切取面积5.0 cm×4.0 cm~11.0 cm×5.0 cm,供区取全厚皮片移植修复。结果4例以足底内侧动脉浅支为蒂的游离足内侧穿支皮瓣移植全部成活,移植后皮瓣的色泽、质地、厚薄与手腕掌部皮肤匹配,外观逼真,不需要二期行皮瓣修薄。患者均获得随访,时间6~12个月。皮瓣两点辨别觉为4~7 mm。供区全厚皮片移植成活良好。末次随访时,根据“中华医学会手外科学会上肢部分功能评定试用标准”评定上肢功能,4例均为优。结论足底内侧动脉浅支为蒂的游离足内侧穿支皮瓣修复手腕掌部深度软组织缺损,血供可靠,质地优良,供区不损伤源主干血管。

Objective To explore the clinical effect of free foot medial perforator flap pedicled with the superficial branch of medial plantar artery for repairing deep soft tissue defects of the wrist and palm.Methods Four cases with deep soft tissue defects of the wrist and palm were repaired with free foot medial perforator flap pedicled with the superficial branch of the medial plantar artery.The defect area of skin soft tissue was 4.5 cm×3.5 cm~10.5 cm×4.5 cm,the cut size of flaps ranged from 5.0 cm×4.0 cm to 11.0 cm×5.0 cm,the donor area was repaired with full-thickness skin transplantation.Results All 4 cases of free foot medial flap pedicled with the superficial branch of the medial plantar artery flaps survived.After transplantation,the color,texture,and thickness of the flap were similar to the palmar skin of the hand,without secondary operation of flap reconstruction.All patients were followed up for 6~12 months.The two-point discrimination of the flap was 4~7 mm,and the full-thickness skin of the donor site survived well after transplantation.At the follow-up,the patient′s upper limb function was evaluated according to the upper limb function evaluation trial standard of the Chinese Medical Association Hand Surgery Society,and 4 cases were all excellent.Conclusions The free foot medial perforator flap pedicled with the superficial branch of the medial plantar artery is reliable in blood supply and excellent in texture.The donor area does not damage the main blood vessels.