胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损★

选择2003-02/2007-02于福州总医院骨科应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损的患者16例，在解剖学基础上，设计胫后动脉穿支筋膜蒂皮瓣，轴线在胫骨内侧髁后与内踝、跟腱间中点的连线，旋转点在最邻近创面、其蒂部在有胫后动脉穿支的轴线上。根据术前超声多普勒血流仪穿支探测，要求皮瓣、蒂部及穿支表面有良好的皮肤。顺行设计皮瓣修复小腿上段，逆行设计修复小腿中下段，其中小腿下段9例，小腿中段3例，小腿上段4例。皮肤软组织缺损范围为2.0 cm×1.5 cm~12.5 cm×7.5 cm，胫后动脉穿支筋膜蒂皮瓣最大面积为15.0 cm×10.0 cm，最小为4.0 cm×2.5 cm。观察其修复效果。术后皮瓣均成活。有2例远端部分皮肤坏死，但其皮下有肉芽生长，其中1例经换药愈合，1例用中厚皮植皮愈合。所有病例均随访半年以上，患肢正常步态行走，有痛觉。应用胫后动脉穿支筋膜蒂皮瓣移植修复小腿皮肤软组织缺损，供区在小腿内后侧，损伤后蒂部保存良好，切取便利，不损伤主要血管，血供可靠，成活率高，是修复小腿皮肤软组织缺损的首选术式之一。

Fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery in repairing leg soft tissue defect

Sixteen patients underwent fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery to repair the skin defects of the middle and lower leg in Department of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from February 2003 to February 2007. Based on anatomy, the flap axis ray was designed as the connection of internal condyle of tibia and the middle point between inner malleolus and achilles tendon, rotating along the axis ray adjacent to wound with pedicle having perforating branches of posterior tibial artery. Under guidance of Doppler flowmeter, all skin including flap, pedicle, and surface of perforating branches must be fine. The upper leg skin defect was repaired using anterograde flap, and the middle-lower leg skin defect was repaired using retrograde flap, including lower leg defect in 9 cases, middle leg defect in 3 cases and upper leg defect in 4 cases. The skin defects ranged from 2.0 cm×1.5 cm to 12.5 cm×7.5 cm, and the largest size of flap was about 15.0 cm×10 cm, and the smallest size of flap was about 4.0 cm×2.5 cm. The repairing effect was observed. All flaps survived. Two cases developed distal necrosis of skin, but granulation was found in subcutaneous tissue, of which 1 case healed after changing dressings, and the other recovered after skin grating. All subjects were followed up for over 6 months. All cases could walk naturally but felt pain. Fasciocutaneous flap pedicle with the perforating branches of posterior tibial artery can repair the skin defects of leg soft tissue. The donor site is posterior leg. The pedicel is kept well after injury, and the flap is easy to design. In addition, the blood supply is reliable, and survival rate is high. It is a good surgery to repair leg soft tissue defect.