外踝上穿支逆行岛状皮瓣与接力邻近皮瓣修复足踝部软组织深度缺损

Lateral supramalleolar perforator reverse island flap combined with relaying adjacent flap for the repair of deep soft tissue defect of foot and ankle

目的 探讨外踝上穿支逆行岛状皮瓣与接力邻近皮瓣修复足踝部软组织深度缺损的临床疗效。方法采用外踝上穿支逆行岛状皮瓣转移修复16例足踝部皮肤软组织深度缺损患者,创面面积7.0 cm×4.0 cm~12.0 cm×6.5 cm,皮瓣设计面积7.0 cm×4.5 cm~15.0 cm×7.5 cm。皮瓣供区从其邻近区域切取腓动脉穿支皮瓣(11例)和腓肠外侧动脉穿支皮瓣(5例)接力转移修复,接力穿支皮瓣面积5.5 cm×3.0 cm~10.0cm×6.0 cm,第二皮瓣供区直接缝合。结果 患者均获得随访,时间6~12个月。术后未发生血管危象。除外踝上穿支逆行岛状皮瓣和腓肠外侧动脉接力穿支皮瓣分别有1块出现小面积坏死外,其余30块皮瓣均完全成活。末次随访时外踝上穿支逆行岛状皮瓣质地、色泽良好;接力邻近皮瓣质地、色泽、厚度与受区皮肤无明显差异;第二皮瓣供区仅留线性瘢痕。结论 采用外踝上穿支逆行岛状皮瓣修复足踝部软组织深度缺损,供区采用接力邻近皮瓣修复,手术简单,效果满意。

Objective To investigate the clinical effect of repairing the deep soft tissue defect of foot and ankle with lateral supramalleolar perforator reverse island flap combined with relaying adjacent flap.Methods The 16 patients underwent lateral supramalleolar perforator reverse island flap reconstruction for treatment of foot and ankle soft tissue deep defects. The defected area was 7. 0 cm × 4. 0 cm ~ 12. 0 cm × 6. 5 cm. The area of lateral supramalleolar perforator reverse island flaps ranged from 7. 0 cm × 4. 5 cm to 15. 0 cm × 7. 5 cm. The relaying perforator flaps in the adjacent regions were used for donor site repairing after lateral supramalleolar perforator reverse island flaps transposition repair. There were 11 cases of peroneal artery perforator flap and 5 cases of lateral sural artery perforator flap. The relaying perforator flaps ranged from 5. 5 cm × 3. 0 cm to 10. 0 cm × 6. 0 cm. Then, the second donor sites were sutured.Results All patients were followed up for 6 ~ 12 months. There was 1 case of small area necrosis in the lateral malleolar superior perforator reverse island flap and the relaying adjacent flap respectively, and they were healed by dressing change. The 30 flaps survived completely without any vascular crisis. At the last follow-up, the texture and color of all lateral supramalleolar perforator reverse island flaps were good,the texture,color and thickness of all relaying adjacent flap were not significantly different from those of the recipient skin, and only a linear scar was left in the donor site of the flap.Conclusions The lateral supramalleolar perforator reverse island flap is used to repair the deep defect of the soft tissue of foot and ankle, and the donor site is repaired with the relaying adjacent flap. The operation is simple and the effect is satisfactory.