小腿穿支螺旋桨皮瓣在儿童足踝部创面修复中的应用

Application of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children

目的探讨小腿穿支螺旋桨皮瓣修复儿童足踝部创面的临床效果。方法回顾分析2018年1月—2021年1月采用小腿穿支螺旋桨皮瓣治疗的28例儿童足踝部创面患者临床资料。男18例,女10例;年龄6~14岁,平均7.3岁。其中交通事故伤8例,慢性感染创面20例。病程2~4个月,平均2.8个月。术中彻底清创后,残留创面范围为5 cm×4 cm~9 cm×5 cm。入院后7~28 d待感染控制后进行手术,根据创面位置、大小和形状,采用彩色超声多普勒定位穿支血管情况,设计并切取穿支螺旋桨皮瓣修复创面,皮瓣切取范围为6 cm×5 cm~11 cm×6 cm。其中2例联合游离皮片移植覆盖创面。供区直接缝合(22例)或植皮修复(6例)。结果术后26例皮瓣成活,其中20例创面Ⅰ期愈合,6例穿支螺旋桨皮瓣小桨端出现表皮坏死,经换药后愈合;2例出现静脉危象后坏死,行股前外侧游离皮瓣移植后愈合。供区创面均Ⅰ期愈合。28例患儿均获随访,随访时间6~24个月,平均10.5个月。皮瓣质地好,小腿整体外形良好,下肢运动功能满意。末次随访时美国矫形足踝协会(AOFAS)评分为(89.8±8.0)分,与术前(79.6±10.4)分比较差异有统计学意义(t=-11.205,P<0.001);获优20例、良6例、可2例,优良率为92.8%。结论儿童小腿穿支螺旋桨皮瓣有其自身特点,是一种修复儿童足踝部创面的可靠方法。

Objective To investigate the effectiveness of perforator propeller flap of lower limb in the treatment of foot and ankle defect in children.Methods The clinical data of 28 children with foot and ankle defect treated with perforator propeller flap of lower limb between January 2018 and January 2021 were retrospectively analyzed.There were18 boys and 10 girls with an average age of 7.3 years(range,6-14 years).There were 8 cases of traffic accident injury and 20 cases of chronic infection wound.The disease duration was 2-4 months,with an average of 2.8 months.After thorough debridement,the residual wound size ranged from 5 cm×4 cm to 9 cm×5 cm.Repairing was performed after 7-28 days of the infection in control.According to the location,size,and shape of the wound,the perforating vessels were located by ultrasonic Doppler,and the perforator propeller flap(area ranged from 6 cm×5 cm to 11 cm×6 cm)was designed and harvested to repair the wound.Flap transfer combined with free split-thickness skin graft covered the wound in 2 cases.The donor site was sutured directly(22 cases)or repaired with skin graft(6 cases).Results Twenty-six flaps survived,of which 20 cases were in primary healing,and 6 cases had epidermal necrosis at the end of small paddle,which healed after dressing change.Necrosis occurred in 2 cases due to venous crisis which healed after anterolateral femoral flap free transplantation.Primary wound healing was achieved in donor site.All 28 children were followed up 6-24 months(mean,10.5 months).The texture,shape,and motor function of the lower limb was satisfactory.At last follow-up,the American Orthopaedic Foot and Ankle Association(AOFAS)score was 89.8±8.0,which was significantly different from the preoperative score(79.6±10.4)(t=-11.205,P<0.001);20 cases were excellent,6 cases were good,and 2 cases were poor,and the excellent and good rate was 92.8%.Conclusion The perforator propeller flap of lower limb in children has its own characteristics.It is a reliable method to repair the foot and ankle defect in children.