腓动脉穿支皮瓣修复小腿中下段胫前软组织缺损

Peroneal artery perforator flap for repairing anterior tibial soft tissue defect of middle and lower leg

目的探讨腓动脉穿支皮瓣修复小腿中下段胫前软组织缺损的临床疗效。方法2016年1月-2019年3月采用腓动脉穿支皮瓣修复小腿中下段胫前软组织缺损共15例,创伤面积3.2 cm×2.5 cm~12.7 cm×5.3 cm。术前根据缺损处创面大小、位置以及形状,选择距离缺损部位最近的穿支做为旋转点设计小腿外侧腓动脉穿支皮瓣,术中分离皮瓣后旋转覆盖创面,间断缝合皮瓣。供瓣区以大腿内侧刃厚皮片修复。结果术后13例皮瓣全部成活,2例皮瓣远端小面积表皮坏死,经严格换药处理表皮剥脱后创面愈合,皮瓣供区植皮均一期愈合。经6~9个月随访,皮瓣外表无臃肿,质地柔软,颜色接近周围正常皮肤,无表面破溃现象。供区皮肤未见明显色素沉着,感觉稍减退。结论以腓动脉穿支皮瓣修复小腿中下段胫前皮肤软组织缺损具有修复面积大、手术损伤小、住院时间短、术式简便易行、术中不损伤知名血管、术后皮瓣成活率高、术后外观自然等优点,值得临床推广。

Objective To explore the clinical effect of Peroneal artery perforator flap on repairing soft tissue defects in the middle and lower part of lower leg.Methods From January 2016 to March 2019,15 patients whose wound area was 3.2 cm×2.5 cm~12.7 cm×5.3 cm with anteriortibial skin and soft tissue defects in the middle and lower leg were admitred to author's unit to treat with peroneal artery perforator flap.Preoperatively,according to the size,location,and shape of the wound at the defect site,the nearest perforating branch to the defect site was selected as the turning point to design the lateral leg peroneal artery perforator flap,which was rotated to cover the wound after separating the flap during surgery,and the flap was sutured intermittently.The donor site was repaired with a split-thickness skin graft from the inner thigh.Results Thirteen cases of skin flap survived completely,2 cases had small area of epidermal necrosis at the distal end of skin flap.The wound healed after strict dressing change.The skin graft at the donor site of skin flap healed by first intention.After a follow-up of 6 to 9 months,the flap had no bloated appearance,soft texture,color close was to the surrounding normal skin,and had no surface ulceration.Conclusion Peroneal artery perforator flap has the advantages of large repairable area,small surgical injury,shorter hospital stay,simple and easy operation,no damage to well-known blood vessels during operation,higher survival rate of flap after operation,and natural appearance after operation,therefore it is worthy of being widely popularized in the clinical application.