腓肠内侧动脉穿支皮瓣修复四肢软组织缺损

目的探讨腓肠内侧动脉穿支皮瓣修复四肢软组织缺损的临床效果。方法 2014年1月—2016年6月,西南医科大学附属中医医院手外科应用腓肠内侧动脉穿支皮瓣修复四肢软组织缺损10例,其中男性7例,女性3例,年龄19~58岁,平均年龄38.5岁。致伤原因:道路交通伤6例,机械损伤3例,压榨伤1例。手部软组织缺损6例,足背软组织缺损4例;缺损面积8cm×4cm~12.5cm×8cm,平均面积为10.5cm×6cm。术前均采用彩色超声多普勒血流探测仪检测穿支血管,术中记录穿支血管的数目和血管蒂长度。切取皮瓣范围8.5cm×4cm~13cm×8cm,5例供区直接缝合,供区宽度5cm,取腹部或大腿部中厚皮片植皮修复。受伤至皮瓣移植时间为2~4周。结果 10例皮瓣全部顺利成活。术后随访6~18个月,受区皮瓣外形美观、无臃肿、质地好、功能满意;供区愈合良好,无明显凹陷。结论腓肠内侧动脉穿支皮瓣血供丰富,血管解剖位置恒定,厚薄适中,是一种修复四肢软组织缺损较好的方法。

Medial sural artery perforator free flap for the repair of limb soft tissue defects

Objective To explore clinical effects of the medial sural artery perforator free flap in the repair of limb soft tissue defects.Methods From Jan.2014 to Jun.2016,10 cases of soft tissue defects of the limbs were re-paired with perforator flap of the medial sural artery in the Department of Hand Surgery ,Chinese Traditional Medicine Hospital Affiliated to Southwest Medical University ,including 7 males and 3 females,age ranged between 19 and 58 (average age 38.5) years.There were 6 cases of road traffic injuries,3 cases of mechanical injuries and 1 case of crush injury.There were 6 cases of soft tissue defects in the hand ,4 cases of soft tissue defect in the dorsal foot.De-fect area was in the range of 12.5cm×8cm-8cm×4cm,with an average area of 10.5cm×6cm.The color doppler flow detector was used to detect perforator vessels before operation ,the number of perforator vessels and vascular pedicle length were recorded intraoperatively.Flap cutting ranged between 8.5cm×4cm and 13cm×8cm,and supply area in 5 cases were directly sutured.The supply area width was greater than 5cm,and was repaired with skin grafts in the ab-domen or thighs.The time was 2 to 4 weeks for flap transplantation after surgery.Results All of the flaps survived successfully.Patients were followed up for 6 to 18 months.The transplanted flap was beautiful in appearance,free from bloated,and had good texture and satisfactory function.The supply area healed well and there was no significant depres-sion.Conclusion The medial sural artery perforator free flap is a good method for repairing soft tissue defects of the limbs,which is rich in blood supply,has a constant vascular anatomy and is moderate in thickness.