胫前动脉踝上穿支皮瓣修复足踝部软组织缺损19例

目的探讨胫前动脉踝上穿支皮瓣修复足踝部软组织缺损的临床疗效。方法回顾性研究2018年4月至2019年6月采用胫前动脉踝上穿支皮瓣修复足踝部软组织缺损19例的资料,其中男11例,女8例;年龄为21~75岁,平均39岁。根据前踝上穿支皮瓣解剖学基础,按照足踝部软组织缺损大小和形状,在小腿下端前外侧设计并切取皮瓣转位修复创面。切取胫前动脉踝上穿支皮瓣面积为6.0 cm×5.0 cm^14.0 cm×8.0 cm,均为带蒂皮瓣转位。根据皮瓣成活、感染控制、弹性色泽、外观形态、供区瘢痕、皮肤感觉、患者认可等情况,对患者足踝部软组织缺损的修复情况进行综合评价。结果本组19例皮瓣全部成活,软组织缺损、肌腱、骨质及钢板外露均得以修复。供区均I期愈合。术后门诊随访2~16个月,皮瓣血运良好,颜色接近周围正常皮肤,臃肿不明显,患者对外观表示满意;供区皮片愈合良好,无明显增生、挛缩及溃疡,踝关节功能良好。结论胫前动脉踝上穿支皮瓣是修复足踝部软组织缺损较为理想的方法之一,手术操作简便,穿支较恒定,血供可靠,具有一定的临床应用价值。

Application of the flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of soft tissue defects in foot and ankle

Objective To explore the clinical effects of the flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of the soft defects in foot and ankle.Methods A retrospective study was carried out to analyze 19 patients with soft tissue defects in foot and ankle. Ninteen patients, which were 11 males and 8 females and aged 21-75 (mean, 39) years, received the surgery between April, 2018 and June, 2019. According to the anatomy of superior malleolus perforating flaps and the size and shape of the soft tissue defects in foot and ankle, flaps were designed and harvested in the anterolateral side of the shank. The sizes of flaps were 6.0 cm×5.0 cm-14.0 cm ×8.0 cm. Evaluation of clinical effects included flap survival, infection control, the elasticity, color, appearance and scars of the donor sites, skin sensations and patient satisfaction. The swelling of flap was also took into an account.Results All 19 flaps survived after the surgery. The soft tissue defects and exposure of tendon, bone and steel plate were repaired very well. Both the donor and recipient sites healed at stage I. Duration of out-patient clinic followed-up was 2-16 months. All flaps survived very well with good shape, and the color and elasticity were very close to the nearby normal skin. Scars at donor sites were small and the functions of ankle and foot were satisfactory.Conclusion The flap pedicled with superior malleolus perforator of anterior tibial artery in reconstruction of the soft tissue defect in foot and ankle delivered satisfactory clinical effects. This flap has reliable perforating blood vessels hence reliable blood supply with high survival rate of flaps. It is one of the simple, safe and optimal methods to repair soft tissue defects in foot and ankle.