高频彩超在胫后动脉穿支皮瓣修复胫骨前内侧钢板外露中的应用

目的探讨采用高频彩超定位胫后动脉穿支获取胫后动脉穿支皮瓣来修复胫骨远端骨折术后前内侧钢板外露的临床疗效。方法选取2018年1月至2020年12月温州市中医院收治的胫骨远端骨折术后前内侧钢板外露而拟行胫后动脉穿支皮瓣修复的患者11例,利用高频彩超进行术前探测定位胫后动脉穿支,在创面彻底扩创后,采用胫后动脉穿支皮瓣修复钢板外露创面。记录利用高频彩超探查到的动脉穿支数并对穿支进行直径及流量测量。术后定期随访,记录皮瓣成活情况及并发症情况。结果11例患者中在拟切取皮瓣的11个胫后动脉区域共找到27支穿支,每个区域找到(2.60±0.45)个穿支。穿支动脉直径(2.50±0.31)mm。随访6~12(8.5±1.9)个月,皮瓣均成活良好,无软组织感染及骨髓炎等并发症。结论胫后动脉穿支皮瓣修复胫骨远端骨折术后前内侧钢板外露创面简单有效,高频彩超能准确定位胫后动脉穿支血管并了解受区情况,是提高穿支皮瓣手术准确性和成功率的有效方法。

Objective To explore the clinical efficacy of applying posterior tibial artery perforator flap by preoperative high frequency color ultrasound(HFCUS)localization for treating tibial anterior medial plate exposure after distal tibial fracture.Methods Eleven cases with tibial anterior medial plate exposure repaired by posterior tibial artery perforator flap using HFCUS localization preoperatively after thorough debridement from January 2018 to December 2020 were selected.The numbers,diameters and blood flow volumes of the perforator arteries were recorded preoperatively by the HFCUS.Every patient was follow-up regularly to record the flap survival condition and related complications after the surgery.Results Totally 27 perforator arteries were found by preoperative HFCUS in 11 donor site.There were mean(2.6±0.45)perforator arteries were detected in every donor site.The mean diameter of perforator arteries were(2.50±0.31)mm.Patients were followed-up for 6~12(8.5±1.9)months,11 flaps survived well without soft or bone tissue infecting and the appearance and function of these flaps were satisfactory.Conclusion It is a simple and versatile procedure by preoperative HFCUS localization of posterior tibial artery perforator to applying posterior tibial artery perforator flap for repairing tibial anterior medial soft-tissue defect with plate exposure after distal tibial fracture.HFCUS is an accurate and successful technique in designing posterior tibial artery perforator flap.