游离腓动脉穿支皮瓣修复前足皮肤缺损

目的：探讨应用游离腓动脉穿支动脉皮瓣修复前足软组织缺损的方法和临床效果。方法：2007年6月至2011年6月，11例前足皮肤软组织缺损，其中男10例，女1例；年龄23～46岁，平均28．6岁；车祸伤4例，压砸伤3例，机器绞伤4例。缺损面积为2．0 cm×4．0 cm～4．0 cm×8．5 cm。11例均为前足复合组织缺损。采取急症或亚急诊游离腓动脉肌皮穿支动脉皮瓣移植修复。受伤至手术时间6～96 h，平均31．8 h。切取面积2．5 cm×4．5 cm～4．0 cm×9．0 cm。动脉血管蒂与受区采用端端吻合。结果：术后皮瓣全部成活。9例获得随访，时间6～24个月，皮瓣略臃肿，外观及弹性良好，功能较好，皮瓣供区组织损伤轻，较小的缺损，供区可直接缝合，即便植皮，瘢痕较小且隐蔽。结论：腓动脉穿支动脉动脉皮瓣的血管解剖恒定、皮瓣厚薄适中，操作简单，是修复前足软组织中小面积缺损的有效方法。

Free perforating flap of peroneal artery for repairing the forefoot skin defects

Objective: To explore the clinical techniques and effects of repairing skin defects of the forefoot by free perforating flap nourished by peroneal artery. Methods: From June 2007 to June 2011,11 patients with skin and soft tissue defects of the forefoot were repaired by free peroneal artery perforating flap in emergent or subemergent. There were 10 males and 1 female with an average age of 28.6 years old ranging from 23 to 46 years old. Among them,4 cases injured for traffic accidents,3 for crush and 4 for machine strangulation. In all cases,the defect area of forefoot tissue varied from 2.0 cm×4.0 cm to 4.0 cm×8.5 cm,and the adopted area varied from 2.5 cm×4.5 cm to 4.0 cm×9.0 cm. The operation time was from 6 to 96 h (averaged 31.8 h). The blood vessels were anastomosed end-to-end. Results: All of the transferred free flaps survived uneventfully. Nine of them were successfully followed up from 6 to 24 months. The appearance,elasticity and functions of flaps were satisfied accompanied with slight damage of donor site although seemed bloated. The smaller donor site could be intimately seamed if necessary. Conclusion: The vessels anatomy of knee with antegrade extended peroneal artery was relative constant with a moderate thickness and simple operation,is useful to repair small or middle areas of skin defects in forefoot.