踝前穿支蒂跨区供血皮瓣的设计与临床应用

目的　探讨踝前穿支皮瓣解剖基础与临床疗效，为足踝部皮肤软组织缺损修复提供选择。方法　根据踝前穿支皮瓣解剖学特征，按照足踝部创面皮肤缺损的大小、形状，在小腿下段前面设计并切取踝前穿支皮瓣转位修复足踝创面15例，皮瓣面积最大为15.0 cm×6.0 cm，最小面积为4.0 cm×3.5 cm。 结果　本组15例皮瓣，术后成活顺利，其中Ⅰ期愈合14例，皮瓣远端皮缘坏死1例（换药治疗后愈合）。术后常规随访3~24个月，皮瓣外形及颜色优良，供区无溃疡，患足负重行走无障碍。 结论 　踝前穿支血管较为恒定、血供可靠，可设计4种类型穿支皮瓣或穿支蒂跨区供血皮瓣修复足踝部软组织缺损创面，是临床修复足踝部皮肤缺损较为理想方法之一。

Design and clinical application of anterior malleolus perforating extended flap

Objective To investigate the anatomical basis and clinical efficacy of the anterior malleolar perforator flaps,so as to provide a supplementary choice for repairing the soft tissue defects of ankle and foot.Methods 15 cases of foot and ankle defects were repaired to use the anterior malleolar perforator flaps,which were designed based on the anatomical study of the anterior malleolar perforator flaps,the size and shape of the wound defects.The size of the flaps ranged from 4.0 cm×3.5 cm to 15.0 cm×6.0 cm.Results All the flaps survived successfully except for 1 case which appeared necrosis at the distal edge of flap and healed after dressing change.After a follow-up of 3 to 24 months,the flaps presented an excellent appearance and color and the donor sites healed without any ulcer,meanwhile,the function of weight-bearing walking was good.Conclusions Four types of perforator flaps or a perforating extended flap could be designed based on the anterior malleolar perforating vessels which were constant and reliable in blood supply.The anterior malleolar perforator flaps might become a desirable choice for the repair of soft tissue defects in ankle and foot.