胫后动脉穿支“螺旋桨”皮瓣修复老年踝关节骨折术后踝内侧软组织缺损

Application of"propeller"flap with perforating branch of posterior tibial artery for repairing soft tissue defect of medial malleolus in elderly patients with ankle fracture

目的探讨胫后动脉穿支“螺旋桨”皮瓣修复老年踝关节骨折术后踝内侧软组织缺损的临床疗效。方法回顾性分析2016年11月-2021年2月收治的踝关节骨折术后踝内侧软组织缺损8例老年患者临床资料。术前采用彩色超声多普勒定位穿支血管情况,设计并切取胫后动脉穿支“螺旋桨”皮瓣修复创面。切取皮瓣面积:6.0 cm×10.0 cm~8.0 cm×15.0 cm。术后观察皮瓣的成活、外观、质地、感觉、并发症及供区情况;同时对术前及末次随访时运用美国足踝外科协会(AOFAS)踝-后足评分系统评价的足部功能结果进行比较,评分结果均采用统计学方法进行统计分析。结果28例中,供区一期缝合15例,植皮13例;25例皮瓣全部成活,3例皮瓣出现部分坏死(皮瓣远端1/3~1/4坏死),经清创、负压封闭引流(VSD)、植皮、换药处理后均得到良好愈合。28例均获随访,随访时间6~24个月,平均10.5个月。皮瓣色泽可、质地柔软、外观满意,皮瓣恢复保护性感觉,4例术后供区瘢痕增生明显,皮瓣周围无瘢痕挛缩。踝关节伸、屈功能根据骨折类型的不同,出现不同程度活动受限,末次随访时采用美国足踝外科协会(AOFAS)踝-后足评分系统评定为(90.9±4.8)分,与术前(72.7±1.9)分比较差异有统计学意义(t=18.357,P<0.001);优20例,良5例,差3例,优良率为89.2%。结论老年患者踝关节骨折术后容易出现软组织缺损,应用胫后动脉穿支“螺旋桨”皮瓣修复操作简单、可靠,是修复此类损伤较好的方法之一。

Objective To investigate the clinical repairing effect of the"propeller"flap with perforating branch of posterior tibial artery in elderly patients with medial malleolus soft tissue defect after ankle joint fracture.Methods Clinical data of elderly patients with postoperative medial malleolus soft tissue defect admitted to our hospital from November 2016 to February 2021 were retrospectively analyzed.Color ultrasound Doppler was used to locate perforating vessels,and the"propeller"flap was designed and cut to repair the wound.The flap area was 6.0 cm×10.0 cm~8.0 cm×15.0 cm.The survival,appearance,texture,sensation,complications and donor site of the flap were observed.At the same time,the results of foot function evaluated by the American Association of Foot and Ankle Surgery(AOFAS)ankle-posterior foot scoring system were compared before and at the last follow-up,and the scoring results were statistically analyzed.Results Among 28 patients,15 were sutured at donor site and 13 were treated with skin graft.All 25 flaps survived successfully,and 3 flaps had partial necrosis(1/3 to 1/4 of distal flap necrosis),which healed well after debridement,negative pressure sealing drainage(VSD),skin grafting and dressing change.All 28 patients were followed up for 6 to 24 months(mean 10.5 months).The skin flap had good color,soft texture and satisfactory appearance,and the protective feeling of the skin flap was restored.Postoperative scar hyperplasia was obvious in the donor site of 4 patients,and no scar contracture was found around the skin flap.All patients had limited ankle joint extension and flexion function according to different fracture types at the time of injury.At the last follow-up,the American Association of Foot and Ankle Surgery(AOFAS)ankle and hind foot score was(90.9±4.8),which was statistically significant compared with the preoperative score(72.7±1.9)(t=18.357,P<0.001).20 cases were excellent,5 cases were good and 3 cases were poor,the excellent and good rate was 89.2%.Conclusion Elderly patients with ankle fracture are prone to soft tissue defects after operation,the application of posterior tibial artery perforating"propeller"flap is simple and reliable,and it is one of the better methods for repairing foot and ankle wounds in elderly patients.