基于free-style理念探讨穿支螺旋桨皮瓣在修复踝关节周围软组织缺损的应用

目的 运用free-style理念设计穿支螺旋桨皮瓣修复踝关节周围软组织缺损,探讨其可靠性与临床疗效.方法 回顾性分析2017年9月—2019年6月陕西中医药大学附属医院创伤二科收治的踝关节周围软组织缺损患者34例,男性21例,女性13例;年龄21～69岁,平均47.3岁;道路交通伤10例,重物砸伤6例,高处跌落伤7例...

Exploring the use of perforating propeller flaps in the repair of soft tissue defects around the ankle based on the free-style concept

Objective To explore the reliability and clinical efficacy of using free-style concept to design perforating propeller flaps to repair soft tissue defects around the ankle joint.Methods Totally 34 patients with soft tissue defects around the ankle joint treated in the Second Department of Trauma,Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from Sep.2017 to Jun.2019 were retrospectively analyzed,including 21 males and 13 females,aged 21-69 years,with an average of 47.3 years.Causes of injuries:10 cases of traffic accident injuries,6 cases of heavy object injuries,7 cases of falling injuries from height,6 cases of diabetic foot,and 5 cases of machine strangulation.The scope of soft tissue defect was 4cm×3cm-13cm×7cm.The area of skin flap was 6cm×5cm-16cm×9cm.Preoperative digital guidance was used to design perforator flaps,including 5 cases of superior lateral malleolus,14 cases of posterior tibial artery,8 cases of medial plantar artery,and 7 cases of peroneal artery.After operation,the foot and ankle joint function(AOFAS score),foot and ankle sensory function(BMRC classification),recipient area flap survival,donor area recovery,etc.were observed.Results The 34 patients were followed up for 9 to 18 months,with an average of 13.6 months.Thirty cases had flaps survived within the first stage;3 cases of marginal necrosis were cured after dressing change;1 case of arterial crisis survived after surgery.The skin flap of the recipient area was satisfactory in appearance,and the movement was acceptable.The skin scar contracture of the donor area was rare,and the color and sensation were good.Ankle AOFAS score was 91-96 points,with an average of 93.7 points;ankle BMRC classification showed:S1 grade in 5 cases(14.7%),S2 grade in 6 cases(17.6%),S3 grade in 19 cases(55.9%),and S4 grade in 4 cases(11.8%).Conclusion The propeller-type perforator skin flap design for soft tissue defects around the ankle joint based on the free-style concept has advantages such as high flap survival rate,good recovery of sensorimotor function of the foot and ankle,little damage to the donor site,and good reconstruction of the recipient site.It is an ideal solution for the treatment of soft tissue defects around the ankle joint.