足背动脉逆行岛状筋膜瓣联合植皮在甲皮瓣切取后创面修复中的应用

目的 报告应用足背动脉逆行岛状筋膜瓣联合植皮修复甲皮瓣切取后创面的方法及临床疗效.方法 对8例拇指套脱伤应用甲皮瓣移植修复后,供区创面缺损面积最大为3.5 cm×6.8 cm,最小为2.5 cm×4.9 cm.以足背动脉足底穿支为旋转点,足背动脉体表投影为轴线,在踝前设计足背动脉岛状筋膜瓣,切取足背动脉周缘筋膜组织,结扎足背动脉近端分支,逆行转移至趾切取后的创面,并在筋膜上植全厚皮片、不打包.结果 8例甲皮瓣、筋膜瓣及植皮创面全部存活,对足部血供无影响.术后随访时间为3～18个月,修复后的趾保留正常长度,外形良好,植皮区无挛缩,恢复保护性感觉,趾屈伸活动及下肢行走正常.结论 足背动脉逆行岛状筋膜瓣切取简单,便于旋转,血供丰富,且保留了趾的长度,是修复甲皮瓣切取后遗留创面理想的修复方法.

Abstract：

Objective To report the method and clinical outcomes of covering big toe defects after wrap-around flap transfer with dorsalis pedis artery reversed fascial island flap combined with skin graft. Methods Wrap-around flap transfer was used to reconstruct degloved thumbs in 8 cases,which left soft tissue defects of the big toe ranging from 2.5 cm×4.9 cm to 3.5 cm×6.8 cm. The reverse fascial island flap pedicled by the dorsalis pedis artery was designed at the anterior ankle with the plantar perforator as pivot point and the surface projection of dorsal pedis artery as axis. The fascia around the dorsalis pedis artery was included in the flap. Proximal branches of the dorsalis pedis artery were ligated and the flap was lifted and rotated to cover the big toe defect. Full-thickness skin was grafted on top of the fascial flap. Results All flaps and skin grafts survived. Blood supply of the foot was not compromised. Postoperative follow-up ranged from 3 to 18 months. The length of the donor big toes was preserved. The contour of toes repaired by flaps was good. There was no contracture of skin grafts. Protective sensation was restored. Walking and motion of the toes was normal. Conclusion Dorsalis pedis artery reversed fascial island flap is easy to harvest and rotate. It has rich blood supply. Transfer of this flap can preserve the length and contour of the big toe and therefore is an ideal method to cover donor site defects left by wrap-around flap harvest.

The application of dorsalis pedis artery reversed fascial island flap combined with skin graft to cover donor site defect after wrap-around flap harvest

Objective To report the method and clinical outcomes of covering big toe defects after wrap-around flap transfer with dorsalis pedis artery reversed fascial island flap combined with skin graft. Methods Wrap-around flap transfer was used to reconstruct degloved thumbs in 8 cases,which left soft tissue defects of the big toe ranging from 2.5 cm×4.9 cm to 3.5 cm×6.8 cm. The reverse fascial island flap pedicled by the dorsalis pedis artery was designed at the anterior ankle with the plantar perforator as pivot point and the surface projection of dorsal pedis artery as axis. The fascia around the dorsalis pedis artery was included in the flap. Proximal branches of the dorsalis pedis artery were ligated and the flap was lifted and rotated to cover the big toe defect. Full-thickness skin was grafted on top of the fascial flap. Results All flaps and skin grafts survived. Blood supply of the foot was not compromised. Postoperative follow-up ranged from 3 to 18 months. The length of the donor big toes was preserved. The contour of toes repaired by flaps was good. There was no contracture of skin grafts. Protective sensation was restored. Walking and motion of the toes was normal. Conclusion Dorsalis pedis artery reversed fascial island flap is easy to harvest and rotate. It has rich blood supply. Transfer of this flap can preserve the length and contour of the big toe and therefore is an ideal method to cover donor site defects left by wrap-around flap harvest.