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。

Clinical application of distally based lateral leg flap supplied by the perforating branch of the peroneal artery

Objective To investigate the use of distally based lateral leg flap supplied by the perforating branch of the peroneal artery in reconstruction of soft tissue defect and bone infection in the ankle and foot. Methods From March 2007 to September 2010,23 patients with soft tissue （ Achilles tendon） defects and bone infection in the ankle and foot were treated with distally based lateral leg flap supplied by the perforating branch of the peroneal artery. The vascular pedicle of the flap was the terminal branch of the peroneal artery and the axis was the sural nerve nutrition blood vessel. The distal leg or ankle soft tissue defects were repaired by using island sural nerve （composite） flap or muscle flap blood - supplied by the perforating branch of the distal - segment peroneal artery. Flaps were from 3 cm ×5 cm to 10 cm × 18 cm in size. Results The flaps in 21 cases survived completely and the wounds were healed at stage I .The edge part of 2 flaps developed necrosis and was healed after debridement and skin grafting. The average hospital stay was 21 days. After follow - up of 2 to 9 months, the flaps had fine texture and appearance. No pigmentation and ulcers were found. The sensory recovery of the flap reached about S2. The patients who received Achilles tendon reconstruction achieved functional position and could return to work. Conclusion Use of the distally based lateral leg flap supplied by the perforating branch of the peroneal artery is effective in the treatment of soft tissue defect and bone infection in the ankle and foot.