游离腓肠内侧动脉穿支皮瓣修复前臂及足部软组织缺损

目的 探讨应用腓肠内侧动脉穿支皮瓣(MSAP)修复前臂及足部软组织缺损的临床效果.方法 自2015年5月至2017年9月,应用MSAP修复前臂及足部软组织缺损创面13例,其中男9例,女4例,年龄19~57岁,平均41岁;其中前臂6例,足部7例,足部创面均位于前中足.皮瓣切取面积为3.0 cm×4.0 cm^7.0 cm×15.0 cm.修复足部创面时均选用同侧小腿,小腿供区创面均进行一期直接缝合.术后通过门诊复查及微信方式,对皮瓣外形、感觉及供区恢复情况进行定期随访.结果 13例皮瓣全部成活,无血管危象发生及坏死,3例术后存在感染,给予换药及抗炎治疗后创面逐渐愈合.术后随访11例(2例外省患者失访),随访时间4~18个月,平均12个月,未发现供区明显功能障碍,受区皮瓣外形良好;7例感觉恢复至S2~S3,TPD 6~9 mm.结论 游离MSAP不损伤主干血管,血管蒂长,穿支恒定,皮下脂肪相对较薄,游离移植修复前臂及足部创面效果良好.

Application of free medial sural artery perforator flap to repair soft tissue defects of forearm and foot

Objective To reconstruct and repair forearm and foot injuries with soft tissue defect using medial sural artery perforator flap(MSAP),and to evaluate the curative effects.Method From May,2015 to September,2017,13 patients(9 males and 4 females)with soft tissue defect on forearm and foot underwent MSAP reconstruction operations.The age was ranged from 19 to 57(mean 41)years.Six wounds located in forearms and 7 in foot.Ipsilater-al shank was used as donor for the repair of foot.The donor sites were directly sutured.The area of flaps was ranged from 3.0 cm×4.0 cm-7.0 cm×15.0 cm.All cases were followed-up for flap appearance,sensation and donor healing by visit of clinic and WeChat reviews.Results All 13 flaps survived well without any vascular crisis nor necrosis.Postoperative superficial infections were found in 3 cases,and the wound healed gradually after daily dress changing and anti-infection treatment.Eleven patients were followed-up for 4 to 18 months(average 12 months).Two provincial patients lost to follow-up.No obvious disfunction was found from the donor shanks.The appearance and texture of flaps were in excellent condition and satisfactory.The sensation of 7 flaps was recovered to S2-S3.TPD was 6-9 mm.Conclusion The free MSAP is rational therapeutic strategy for repairing the soft tissue defect of forearm and foot.It has advantages of long vascular pedicle,constant perforation and relatively thin subcutaneous fat.