显微外科皮瓣修复[足母]甲瓣供区的临床应用

目的探讨应用显微外科皮瓣对[足母]甲瓣供区进行修复的临床疗效,并对皮瓣选择做出分析。方法应用5种近位足部带蒂皮瓣和2种远位游离皮瓣对57例[足母]甲瓣供区软组织缺损进行修复。其中近位带蒂皮瓣33例:带蒂足跗外侧动脉皮瓣2例,以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣15例,带第1跖背动脉的足背逆行皮瓣3例,顺行足第2趾胫侧皮瓣11例,逆行足底内侧皮瓣2例,足部皮瓣供区行全厚皮片游离植皮。远位游离皮瓣24例:游离腹股沟皮瓣13例,游离股前外侧皮瓣11例。皮瓣供区均直接缝合。结果57例皮瓣中53例成活良好;以第1跖背动脉的跖蹼穿支为蒂的足背逆行皮瓣3例远端部分坏死,经换药治疗后创面愈合;游离腹股沟皮瓣1例术后发生血管危象,经血管探查术后未缓解,Ⅱ期行游离植皮修复[足母]甲瓣供区创面。术后随访2~12个月,行走姿态良好。结论合适的显微皮瓣技术可以良好的修复[足母]甲瓣供区创面,保全肢体的完整性,减少医源性损伤,患者更容易接受[足母]甲瓣移植的手术方式。皮瓣选择不应只关注[足母]趾供区的修复,更应合理运用显微皮瓣技术,重视供、受区的平衡。

Application analysis of microsurgical flap to repair the donor site of wrap-around flap

Objective To discuss the clinical effect of microsurgical flap on repairing the wrap-around flap donor site and to analyze the selection of flap.Methods Five kinds of proximal pedicled foot flaps and two kinds of distal free skin flaps were used to repair soft tissue defect of wrap-around flap donor site in57 cases.The proximal pedicled foot flaps:2 cases of pedicled foot tarsus lateral artery flap,15 cases of reverse flap of the dorsal foot pedicled with the web of the plantar branch of the first dorsal metatarsal artery,3 cases of dorsal flap of the foot with the first dorsal metatarsal artery,11 cases of anterograde foot tibial flap of the second toe,2 cases of retrograde medial plantar flap.skin grafting with full thickness was performed in the donor area of the foot flaps.Distal free skin flaps:13 cases of free inguinal flap,11 cases of free anterolateral femoral flap.Flap donor area was sutured directly.Results Fifty-three of Fifty-seven cases survived with satisfactory appearance.3 of 15 reverse flaps had partial necrosis,which pedicled with the web of the plantar branch of the first dorsal metatarsal artery,but healed after wound dressing.1 case of free inguinal flap had vascular crisis,surgical exploration failed.In the second stage,free skin grafting was performed to repair the wound in the donor area of nail flap.The patients were followed up for 2~12 months,which got satisfactory walking gait.Conclusion Proper microsurgical flap can repair the wrap-around flap donor site well,preserve the integrity of the limb and reduce iatrogenic injury,which make patients easier to receive the wrap-around flaps.The selection of flap should not only focus on the repair of the donor area of hallux toe,The microsurgical flap should be used reasonably and the balance between donor and recipient area should be paid attention to.