游离穿支孪生复合组织瓣修复第1跖骨头及软组织缺损

目的探讨应用带胫骨（膜）瓣及隐神经的胫后动脉穿支孪生复合组织瓣游离移植修复足弓及第1跖骨头部感觉神经及软组织缺损的临床应用效果。方法2008年02月一2012年02月临床应用5例，均为拇趾及第1跖骨头毁损、前足软组织缺损，前足纵横弓完整性破坏。选择以胫骨滋养动脉或胫后动脉发出的骨（膜）皮穿支血管为蒂，切取带胫骨（膜）瓣及隐神经的胫后动脉穿支血管供血的孪生复合组织瓣游离移植修复第1跖骨头及软组织缺损，骨瓣切取大小为1．5cm×0．8cm×0．6cm～4．0cm×1．5cm×1．0cm，皮瓣切取为5．0cm×3．5cm～7．0cm×6cm。结果术后皮瓣全部成活，术后3个月足部皮瓣有部分感觉恢复。随访6～24个月，皮瓣外形满意，骨折骨性愈合，可负重行走，行走步态接近正常，前足部皮瓣感觉恢复达S3。结论该术式保留了足弓外形及负重支撑点，行走和负重良好，外形及功能满意，有感觉。具有创伤小、供区部位隐蔽、不牺牲主干血管，手术操作简便等优势，一次手术即可使第一跖骨及周围组织达到满意的解剖塑形及良好功能。是一种较理想的治疗方法。

Repair of the first metatarsal head and soft tissue defects with free perforator twins composite flaps

Objective To investigate the clinical effect of repairing the arch and sensory nerves and soft tissue defects of the 1 st metatarsal head by posterior tibial artery perforating branches twins composite flaps with bones or periosteals and saphenous nerve. Methods From February 2008 to February 2012, there were 5 cases with defect of halluxes and the first metatarsal heads and soft tissue of forefoot. Those arch of foot and sensory nerves and soft tissue defects of forefoot were reconstructed at one stage by twins＇ composite flaps blood - supplied by posterior tibia artery perforator vessels with bones or periosteals and saphenous nerve. Results All flaps survived. Three months after operation, the sensory of some feet flaps recovered partially. Followed up of 6 months to 2 years found that flaps shape was satisfaction, bone fractures were healing; the ability of walking and bearing was satisfying as well as the function and shape, and the front foot flap sensory were all recovered. Conclusion The operation method retains the shape and weight - bearing supporting point of arch, the foot function and feeling are good. This operation （only one-off） is an alternative one to treat bone and soft tissue defect of metatarsal. The donor site is hidden and of less trauma; the operation is easy without sacrificing the core vessels.