负压封闭引流联合腓动脉穿支皮瓣修复外踝部毁损伤创面的疗效

Vacuum sealing drainage combined with peroneal artery perforator flap for repairing lateral malleolus injury

目的:探讨负压封闭引流(VSD)联合腓动脉穿支皮瓣修复外踝部毁损伤创面的临床疗效。方法:选取应用VSD联合腓动脉穿支皮瓣修复足踝部毁损伤创面62例为研究对象,所有患者一期清创后行VSD治疗5~7 d,基底清洁后二期行腓动脉穿支皮瓣皮瓣修复。结果:62例患者中有12例患者术后皮瓣中远端出现回流障碍、淤血情况,经48 h内反复行皮瓣内静脉放血后好转。59例腓动脉穿支皮瓣成活良好,皮瓣远端约1~3 cm出现发黑坏死3例,但基底未见肌腱或骨质外露,经换药后治愈2例,再次清创行自体皮片移植后治愈1例。创面愈合时间12~32 d,平均愈合时间16.5 d;随访时间12~15个月,观察皮瓣柔软,与周缘皮肤颜色相近,耐磨性好,外观功能恢复满意,踝关节活动基本正常,未并发溃疡;据美国矫形足踝协会(AOFAS)评估足踝部功能优良率为100%。结论:采用VSD联合腓动脉穿支皮瓣修复足踝部毁损伤创面能获得良好的效果,后期皮瓣质地良好、厚薄适中、耐磨及外观功能恢复良好。

Objective To explore the clinical effect of vacuum sealing drainage(VSD)combined with peroneal artery perforator flap in repairing the damaged wound of lateral malleolus.Method 62 cases of foot and ankle injuries who were repaired by VSD combined with peroneal artery perforator flap were selected as research object,all patients were treated with VSD for 5~7 days after primary debridement,and peroneal artery perforator flap was repaired in the second stage after basal cleaning.Results Of the 62 patients,12 patients had reflux disorder and congestion in the middle and distal end of the flap after operation,which improved after repeated bleeding in the internal vein of the flap within 48 hours.59 cases of peroneal artery perforator flap survived well;In 3 patients,the distal end of the flap was about 1~3 cm black and necrotic,but no tendon or bone was exposed at the base.Two patients were cured after dressing change,and one patient was cured after debridement and autologous skin graft.After dressing change,the wound healed for 12~32 days,with an average healing time of 16.5 days.Follow-up for 12~15 months showed that the skin flap was soft,similar in color to the peripheral skin,good in wear resistance,satisfactory in appearance and function recovery,basically normal in ankle joint activity,and no complicated ulcer.According to the American Orthopedic Ankle Association(AOFAS),the excellent and good rate of ankle function is 100%.Conclusion VSD combined with peroneal artery perforator flap can achieve good results in repairing the damaged wounds of foot and ankle,and the flap has good texture,moderate thickness,wear resistance and good appearance and function recovery in the later period.