小腿穿支血管筋膜蒂皮瓣修复下肢软组织缺损

目的:探讨小腿穿支血管筋膜蒂皮瓣转移的手术方法和临床效果.方法:1998年5月至2009年1月临床应用带小腿内、后、前外、后外侧穿支血管的筋膜蒂皮瓣邻近转位,对下肢皮肤软组织缺损创面进行修复共62例,男50例,女12例;年龄7～78岁.其中应用带胫后动脉穿支的小腿内侧筋膜蒂皮瓣23例,带腓动脉终末穿支小腿前外侧筋膜蒂皮辩9例,带腓动脉穿支腓肠神经营养血管筋膜蒂皮瓣22例,带腘外侧动脉小腿后外侧筋膜蒂皮瓣8例.结果:除2例术后皮辩远端表皮坏死结痂,1例皮瓣远端部分皮肤坏死行Ⅱ期植皮,其余皮瓣均完全成活.随访1个月～3年,皮瓣外观满意,功能良好.结论:小腿部单个穿支血管供血面积有限,应用带穿支血管营养血管链的筋膜蒂度瓣可扩大小腿皮瓣的裁取面积,保证皮瓣的血供及回流.

Repair of soft tissue defects on the lower limbs with the facial pedicled flap with vascular perforating branch of leg

Objective: To investigate the operative techniques and clinical results of the facial pedicled flap with vascular perforating branch of leg. Methods: From May 1998 to January 2009,62 patients with soft tissue defects on the lower limbs were treated by four kinds of flap pedicled with the medial,posterior,anterolateral and posterolateral vascular perforating branches in the leg,included 50 males and 12 females,aged from 7 to 78 years old. There were 23 cases of the facial pedicled flap based on the perforating branch of the tibialis posterior artery,9 cases of the facial pedicled flap based on the distal perforating branch of peroneal artery,22 cases of the facial pedicled flap based on the peroneal artery perforator,8 cases of the facial pedicled flap based on the lateral popliteal cutaneous artery. Results: The remaining flaps were completely survived except for 2 cases with epidermal necrosis and scab of distal flap,and 1 case with skin necrosis and skingrafting later. The patients were followed-up for from 1 month to 3 years,the appearance of the flaps were satisfied and the function were good. Conclusion: The blood supply area of single perforator vascular of the leg is insufficient,so the presence facial pedicled flap of arterial chains will expend obviously the area of perforator flap that be good to blood supply and venous return.