小腿筋膜皮瓣及小腿内侧逆行轴形皮瓣在下肢创伤修复时的选择及评估

目的:探讨两种小腿皮瓣(小腿筋膜皮瓣及小腿内侧逆行轴形皮瓣)在下肢创伤后皮肤软组织缺损修复时的选择及评估。方法:①在小腿设计局部随意筋膜皮瓣,皮瓣大小范围4cm×6cm～7cm×15cm,转移修复同侧或对侧小腿皮肤软组织缺损并骨外露;②以胫后动脉内踝上发出的皮动脉穿支为轴,在小腿内侧设计逆行轴形皮瓣,皮瓣大小范围4cm×12cm～6cm×15cm,转移修复同侧或对侧足底、踝部、小腿皮肤软组织缺损并肌腱或骨外露。结果:临床共选用11个皮瓣,其中6例为筋膜皮瓣,5例为小腿内侧逆行轴形皮瓣,修复同侧或对侧下肢皮肤软组织缺损并肌腱或骨外露。11例皮瓣术后均成活良好,创面修复效果良好,随访6～12个月,伤肢外形及功能恢复满意。结论:小腿筋膜皮瓣,设计灵活,切取便利,不损伤主要血管,血供丰富,尤其在局部主要血管受损时是修复下肢严重创伤的有效方法之一。小腿内侧逆行轴形皮瓣可切取皮瓣距离长,面积大,血供恒定可靠,成活率高,是修复足底、踝部、小腿严重创伤的最佳选择。此两种皮瓣的应用应针对小腿创面的部位、面积及其创伤特点进行合适的选择,可达到满意的修复效果。

Selection and Evaluation of leg fascio cutaneous flap and medial lower leg retrograde axial pattern cutaneous flap in reconstruction of low limb trauma

Objective To explore selection and evaluation between leg fascio cutaneous flap and medial lower leg retrograde axial pattern cutaneous flap in reconstruction of severe low limb trauma. Methods ①design a random fascio cutaneous flap size range of 4cm×6cm～7cm×15cm in lower leg which is transformed to repair skin tissue defects of ipsilateral or bilateral.②Set the cutaneous artery perforator on posterior tibial artery medial malleolus as rotating point, design a retrograde axial pattern cutaneous flap size range of 4cm ×12cm～6cm ×15cm in medial lower leg which is transformed to repair skin soft tissue defect of foot or ankle and bone or tendon exposure ipsilateral or bilateral. Results The fasical flap was applied in the repair of skin defects or ankle and bone or tendon exposure of 11 cases,include 6 fascio cutaneous flap and 5 retrograde axial pattern cutaneous flap.All healing effect were better,follow-up for 6 to 12 months, the injured limb appearance and the function were satisfactory. Conclusions Random fascio cutaneous flap of lower leg have stable blood supply, facilitate, and no damage to the major vascular. It can repair skin soft tissue defect especially in case of Peripheral Vascular Injuries. Retrograde axial pattern cutaneous flap of the lower leg is spread vertically and is long,area covered is big, blood supply is stable,and has high survival rate that is desirable,so the flaps in repairing vertical long wounds in foot, ankle and calf of dorsal skin soft tissue defect is prefered. These two application of the flaps calf wound site, is characterised by the area of their trauma, so that suitable choice to achieve satisfactory repair can be chosed.