跨区供血小腿前外侧皮瓣修复足部皮肤软组织缺损

目的 探讨应用跨区供血小腿前外侧皮瓣修复足部皮肤软组织缺损的方法及疗效.方法 采用跨区供血小腿前外侧皮瓣逆行转移修复足部皮肤软组织缺损12例,皮瓣切取面积32cm×17cm～15cm×7cm.以腓动脉终末穿支为蒂8例,以腓动脉终末穿支降支为蒂4例.结果 皮瓣完全成活11例,1例术后发生静脉回流障碍,皮瓣远端部分坏死(面积约1.0cm×1.5cm),经换药伤口愈合.随访时间6个月～3年,皮瓣外形满意,供区植皮无溃疡或磨损,行走步态接近正常.结论 采用跨区供血小腿前外侧皮瓣修复足部皮肤软组织缺损,手术操作相对简单,不损伤主干血管,皮瓣供血可靠,是修复足部大面积皮肤软组织缺损的理想皮瓣.     

神经撕拉离断并缺损采取端侧吻合修复的应用

手足部神经撕拉离断是较常见并非常严重复杂的一类创伤。其中神经多由近端抽出,残端呈鼠尾状并伴缺损,难以直接端端吻合,以往多采用神经移植的方法修复,当长度超过10cm,效果多不可靠。我们从2002年以来,重点针对109例手足部神经撕拉离断伴缺损,采用神经端侧吻合的方法重建了患部的感觉功能及运动功能,取得了较为满意的疗效,现总结报道如下。     

不吻合血管的股前外侧皮瓣的临床应用

目的探讨股前外侧皮瓣发生血管变异而无法吻合血管时的临床应用。方法对8例前臂及手部皮肤缺损患者,面对股前外侧皮瓣血管变异无法行血管吻合的情况改用高位穿支为蒂,顺行修复创面。结果术后8例患者皮瓣全部成活,质地柔软。结论该方法是针对目前临床上所遇见的股前外侧皮瓣血管变异无法吻合血管时的有效补充,不用改行其他部位的皮瓣,能减少创伤。     

胫后动脉穿支骨(膜)皮瓣移植修复手部复合组织缺损

Objective To study the methods and effects of repairing composite tissue defects of the hand by transfering posterior tibial artery perforator bone(periosteum) flap.Methods Nine cases of traumatic bone and soft tissue defects in the hand underwent digital subtraction angiography (DSA) of the lower leg preoperatively.According to angiography results and the anatomical characteristics, the tibial nutrient artery or osteoseptocutaneous perforator vessel of the posterior tibial artery was selected as vascular pedicle to harvest tibial artery perforator bone (periosteum) flap.The osteocutaneous flap was transferrede to repair the bone and soft tissue defect in the hand.The volume of the harvested bone ranged from 1.5 cm× 0.6 cm× 0.4 cm to 3.5 cm×0.7 cm×0.5 cm.The area of the skin flap ranged from 4.0cm×3.5cm to 7.0cm×4.0cm.Results All the composite tissue flaps survived completely.Postoperative follow-up for 3 to 18 months revealed that the fracture line disappeared in 3 to 4 months and all fractures healed.According to the TAM system of joint function assessment/provisional upper limb function evaluation standard isled by the Chinese Hand Surgery Society,88.9% of the cases achieved satisfactory results.Conclusion Transfer of posterior tibial artery perforator bone (periosteum) flap is an ideal procedure to repair composite tissue defects of the hand.No major vessel of the donor site is sacrificed.The good size match between the vessels of the donor site and recipient site makes vascular anastomosis easy.Donor site morbidity is minor.Bone healing time is short.     

游离腓浅动脉单一穿支皮瓣移植修复前足中小皮肤软组织缺损

目的 探讨游离腓浅动脉穿支皮瓣修复前足皮肤软组织缺损的临床疗效.方法 13例前足严重创伤患者,急诊给予骨折内固定、血管神经肌腱修复、皮肤回植及封闭式负压引流（VSD）等处理,7～10d后,待组织坏死界限清晰后,进行腓浅动脉单一穿支皮瓣游离移植术,皮瓣切取面积为3.0cm×5.0cm～6.0cm×10.0cm,供区全厚皮打包加压包扎.结果 12例皮瓣全部成活,1例术后出现动脉血管危象,探查后部分成活,植皮后痊愈.10例获得了1个月～2年随访,无色素沉着及溃疡,外观满意.8例感觉达S 3,4例达S 2.结论 游离腓浅动脉单一穿支皮瓣为穿支皮瓣的延伸,符合现代皮瓣移植的最新观点,具有可一期修薄,不牺牲主干血管,解剖相对简单,供区损伤小,手术在同一区域等优点,是修复前足皮肤软组织缺损较为理想的方法 之一.     

基于腓动脉后穿支及腓肠内侧与外侧皮神经营养血管嵌合组织瓣修复跟腱区复合组织缺损

目的探讨基于腓动脉后穿支及腓肠内、外侧皮神经营养血管嵌合组织瓣修复跟腱区复合组织缺损的临床疗效。方法 2016年1月-2021年6月, 联勤保障部队第九八八医院创伤显微骨科共收治伴有跟腱缺损的感染性创面12例, 跟腱区软组织缺损面积为2.5 cm×4.5 cm～8.0 cm×12.5 cm, 跟腱缺损长度3.0～7.0 cm, 均采用以腓动脉后穿支为供血血管, 腓肠内、外侧皮神经营养血管嵌合跟腱皮瓣(ATF)修复。皮瓣切取面积3.0 cm×5.0 cm～9.0 cm×13.0 cm, 切取ATF大小3.0 cm×4.0 cm～3.0 cm×8.0 cm。供区8例直接缝合,4例行植皮修复。术后常规外固定6周, 其后去除外固定并开始逐步进行功能锻炼, 定期行门诊随访, 末次随访时采用Thermann跟腱功能评定系统进行评价。结果术中嵌合ATF切取顺利且各瓣血运好, 术后无血管危象发生, 皮瓣均顺利成活, 伤口甲级愈合。患者均获得随访10～24个月, 皮瓣外观饱满, 稍显臃肿, 色泽与受区相似, 质地柔软, 小腿及踝关节功能恢复良好。按Thermann跟腱功能评定系统进行评估, 结果优8例,...     

高旋转点腓肠神经营养皮瓣修复小腿下段及踝周创面的应用价值

目的 探讨高旋转点腓肠神经营养皮瓣修复小腿下段及踝周创面的应用价值.方法 回顾性分析2017-03—2019-12第九八八医院收治的小腿下段及踝周创面的13例患者的临床资料.其中5例因创面位置较高、8例因低位腓动脉穿支纤细或损伤,不具备常用的以外踝上3～7 cm为旋转点的腓肠神经营养皮瓣修复条件,而行高旋转点(外踝上8...     

胫后动脉穿支骨(膜)皮瓣移植修复手部复合组织缺损

目的 探讨以穿支血管为蒂胫后动脉穿支骨(膜)皮瓣游离移植修复手部复合组织缺损的方法及疗效.方法 对9例外伤性手部骨、皮肤软组织缺损患者,术前行小腿部动脉数字减影血管造影,依据胫后动脉造影结果及解剖特点,选择以胫骨滋养动脉或胫后动脉发出的骨(膜)皮穿支血管为蒂,切取胫后动脉穿支胫骨骨(膜)皮瓣,游离移植修复手部骨和皮肤软组织缺损.骨瓣切取大小为1.5 c×0.6 cm×0.4cm～3.5cm×0.7cm×0.5 cm.皮瓣切取面积为4.0 cm×3.5 cm～7.0 cm×4.0 cm.结果 术后9例复合组织瓣完全存活,随访时间为3～18个月,骨缺损植骨处骨折线于术后3～4个月消失,骨折全部愈合.按照中华医学会手外科学会上肢部分功能评定试用标准中总主动活动度(TAM)系统评定法进行关节功能评价,优良率为88.9%,效果满意.结论 对于各种原因造成的手部复合组织缺损,采用胫后动脉穿支胫骨骨(膜)皮瓣游离移植修复,不牺牲主干血管,供区与受区血管管径相当,便于血管吻合,组织移植后对供区影响小,骨愈合时间短,是一种较理想的治疗方法.

Abstract：

Objective To study the methods and effects of repairing composite tissue defects of the hand by transfering posterior tibial artery perforator bone(periosteum) flap.Methods Nine cases of traumatic bone and soft tissue defects in the hand underwent digital subtraction angiography (DSA) of the lower leg preoperatively.According to angiography results and the anatomical characteristics, the tibial nutrient artery or osteoseptocutaneous perforator vessel of the posterior tibial artery was selected as vascular pedicle to harvest tibial artery perforator bone (periosteum) flap.The osteocutaneous flap was transferrede to repair the bone and soft tissue defect in the hand.The volume of the harvested bone ranged from 1.5 cm× 0.6 cm× 0.4 cm to 3.5 cm×0.7 cm×0.5 cm.The area of the skin flap ranged from 4.0cm×3.5cm to 7.0cm×4.0cm.Results All the composite tissue flaps survived completely.Postoperative follow-up for 3 to 18 months revealed that the fracture line disappeared in 3 to 4 months and all fractures healed.According to the TAM system of joint function assessment/provisional upper limb function evaluation standard isled by the Chinese Hand Surgery Society,88.9% of the cases achieved satisfactory results.Conclusion Transfer of posterior tibial artery perforator bone (periosteum) flap is an ideal procedure to repair composite tissue defects of the hand.No major vessel of the donor site is sacrificed.The good size match between the vessels of the donor site and recipient site makes vascular anastomosis easy.Donor site morbidity is minor.Bone healing time is short.     

以腓动脉远端穿支血管供血为蒂的小腿后外侧（复合）组织瓣的临床应用

目的探讨腓动脉穿支供血的小腿后外侧（复合）组织瓣在足踝部软组织缺损、骨感染修复中的临床效果。方法2007年3月至2010年9月,对23例足踝部软组织（跟腱）缺损及骨感染的患者,设计以腓动脉终末穿支为血管蒂,沿腓肠神经营养血管轴线切取皮瓣转位修复小腿下段及足踝部皮肤软组织缺损。采用腓动脉下段穿支供血携带腓肠神经逆行岛状（复合）皮瓣或肌皮瓣进行修复。皮瓣切取范围3cm×5cm～10cm×18cm。结果术后21例皮瓣完全成活,创面一期愈合,2例皮瓣边缘部分坏死,后经过二期扩创游离植皮后痊愈,平均住院时间21d。随访2～9个月,皮瓣质地优良,外观满意,无色素沉着、溃疡,皮瓣感觉恢复约S2,跟腱重建患者踝关节达功能位,恢复了劳动能力。结论以腓动脉远端穿支血管供血为蒂的小腿后外侧（复合）组织瓣血供可靠,变异率低,切取方便,供区隐蔽,可恢复部分感觉,且不牺牲肢体主要血管,是修复小腿中下部、踝关节周围及足部软组织缺损的一种良好方法。尤其对修复足踝部骨外露,骨髓炎,跟腱缺损,复合组织瓣（携带跟腱及肌肉）是一种较好的选择。     

胫后动脉穿支骨(膜)皮瓣移植修复手部复合组织缺损

Objective To study the methods and effects of repairing composite tissue defects of the hand by transfering posterior tibial artery perforator bone(periosteum) flap.Methods Nine cases of traumatic bone and soft tissue defects in the hand underwent digital subtraction angiography (DSA) of the lower leg preoperatively.According to angiography results and the anatomical characteristics, the tibial nutrient artery or osteoseptocutaneous perforator vessel of the posterior tibial artery was selected as vascular pedicle to harvest tibial artery perforator bone (periosteum) flap.The osteocutaneous flap was transferrede to repair the bone and soft tissue defect in the hand.The volume of the harvested bone ranged from 1.5 cm× 0.6 cm× 0.4 cm to 3.5 cm×0.7 cm×0.5 cm.The area of the skin flap ranged from 4.0cm×3.5cm to 7.0cm×4.0cm.Results All the composite tissue flaps survived completely.Postoperative follow-up for 3 to 18 months revealed that the fracture line disappeared in 3 to 4 months and all fractures healed.According to the TAM system of joint function assessment/provisional upper limb function evaluation standard isled by the Chinese Hand Surgery Society,88.9% of the cases achieved satisfactory results.Conclusion Transfer of posterior tibial artery perforator bone (periosteum) flap is an ideal procedure to repair composite tissue defects of the hand.No major vessel of the donor site is sacrificed.The good size match between the vessels of the donor site and recipient site makes vascular anastomosis easy.Donor site morbidity is minor.Bone healing time is short.