腓动脉低位穿支螺旋桨皮瓣转位修复足跟部软组织缺损

Transplanted low-set perforating branch propeller flap of fibular artery for repairing calcaneal soft tissue defects

目的探讨应用腓动脉低位穿支螺旋桨皮瓣转位修复足跟部软组织缺损的临床疗效。方法采用回顾性病例系列研究分析2013年1月至2019年12月解放军联勤保障部队第九二○医院收治的28例足跟部软组织缺损患者临床资料,其中男19例,女9例;年龄13~69岁[(33.8±13.7)岁]。软组织缺损面积为5 cm×2 cm~18 cm×12 cm,皮瓣切取面积为12 cm×4 cm~24 cm×10 cm。根据创面条件分别采用急诊清创、腓动脉低位穿支螺旋桨皮瓣移植修复或清创后Ⅱ期皮瓣移植修复。观察皮瓣成活情况,以及受区、供区创面愈合情况及并发症情况;术前及末次随访时采用美国足踝外科协会(AOFAS)踝-后足评分评估患肢踝关节功能恢复情况;末次随访时采用Thankappan皮瓣外观满意度评分评价皮瓣外观。结果患者均获随访2~40个月[(17.4±5.9)个月]。皮瓣全部成活。创面均愈合,转位皮瓣色泽接近受区皮肤、外形可,均未行皮瓣修薄手术。术后1周内3例皮瓣供区出现切口两侧麻木,术后2个月左右自行恢复正常,1年后所有皮瓣恢复部分浅痛觉。无患肢血运障碍、筋膜间隔综合征等并发症发生。末次随访时AOFAS踝-后足评分为56~95分[(82.3±15.2)分],显著高于术前的17~68分[(35.7±13.4)分](P<0.01),其中优21例,良5例,可2例,优良率为93%。末次随访时Thankappan皮瓣外观满意度评分为4~10分[(7.6±2.9)分],其中优6例,良15例,可7例,优良率为75%。结论腓动脉低位穿支螺旋桨皮瓣转位修复足跟部软组织缺损,皮瓣血运可靠,成活率高,能较好地恢复患肢的外观和功能。

Objective To investigate the clinical efficacy of low-set perforating branch propeller flap of fibular artery for repairing calcaneal soft tissue defects.Methods A retrospective case series study was conducted on 28 patients with calcaneal soft tissue defects admitted to 920th Hospital of Joint Logistics Support Force of PLA from January 2013 to December 2019.There were 19 males and 9 females,aged 13-69 years[(33.8±13.7)years].The size of soft tissue defects ranged from 5 cm×2 cm to 18 cm× 12 cm,and the size of flaps ranged from 12 cmX4 cm to 24 cm×lO cm.The soft tissue defects were repaired with the low-set fibular artery perforator propeller flap after emergency debridement or flap transplantation at the second stage after debridement according to the wound surface conditions.The survival of the flap,wound healing at the recipient and donor sites and complications were recorded.The function of the affected ankle was assessed according to American Orthopedic Foot and Ankle Society(AOFAS)ankle-hindfoot score before operation and at the final follow-up.The degree of satisfaction of flap appearance was assessed by Thankappan flap appearance satisfaction score at the final follow-up.Results All patients were followed up for 2-40 months[(17.4±5.9)months].All flaps survived and wounds at both donor and recipient sites were healed well,with satisfactory color and texture of the flaps,without thinning operation performed.Three patients experienced numbness on both sides of the incision at donor sites within 1 week after operation and returned to normal on their own about 2 months after operation,with all flaps restoring partial light pain sensation 1 year after operation.No complications occurred such as blood flow disorder of the affected limb or compartment syndrome.The AOFAS ankle-hindfoot score was 56-95 points[(82.3±15.2)points]at the final follow-up,significantly higher than the preoperative score of 17-68 points[(35.7±13.4)points](P<0.01).The results were excellent in 21 patients,good in 5 and fair in 2,with excellent and good rate of 93%.The appearance satisfaction score was 4-10 points[(7.6±2.9)points]according to Thankappan flap appearance satisfaction score.The results were excellent in 6 patients,good in 15 and fair in 7,with the excellent and good rate of 75%.Conclusions The low-set perforating branch propeller flap of fibular artery for reconstruction of calcaneal soft tissue defects has advantages of reliable blood supply and high survival rate of the flap as well as good restoration of the appearance and function of the affected limb.