小腿前踝上-足背部串联皮瓣移植修复手部软组织缺损

目的　探讨小腿前踝上 足背部串联皮瓣移植 ,修复手部软组织缺损的手术方法。方法　在解剖学基础上 ,设计以胫前 足背动脉为蒂的小腿前踝上 足背串联皮瓣移植修复手掌、背和手指软组织缺损 8例。结果　 8例皮瓣全部成活 ,供区植皮Ⅰ期愈合。术后 4～ 8个月随访 ,移植皮瓣无明显臃肿 ,皮瓣质地、色泽良好 ,厚度适中。 4例修复神经的移植皮瓣 ,两点分辨觉达 6mm～ 10mm。另 4例皮瓣恢复了实体感觉。结论　应用以胫前 足背动脉为血管蒂的小腿前踝上 足背部串联皮瓣移植 ,血供可靠 ,手术简便、实用 ,是修复手掌、背和手指软组织缺损的良好供区。

Combined anterosuperior malleolus-dorsalis pedis flaps for coverage of skin defect of the hand

ObjectiveThe surgical design of combined anterosuperior malleolus dorsalis pedis flaps was introduced. The treatment outcomes of transferring this flap for coverage of skin defect of the hand were presented also.MethodsBased on anatomic study, a flap at the anterosuperior malleolus area and a flap on dorsum of the foot were designed to include cutaneous branches from the anterior tibial artery and cutaneous branches from the dorsalis pedis artery, respectively. The two flaps were harvested as a chain linked combined tranplant that used the anterior tibial artery as the inflow artery. Clinical application of the chain flaps involved 8 cases of soft tissue defect of the palm, dorsum of the hand and fingers. The superficial peroneal nerve was included in the flap in 4 cases for nerve repair. The donor areas were covered with full thickness skin graft. All the patients were followed for 4 to 8 months postoperatively.ResultsAll of flaps survived. The flaps were of appropriate thickness, good texture and consistency and matching color. In 4 cases of innervated flaps, 2 point discrimination reached 6 to 10mm. The flaps without nerve repair regained proprioceptive sense.ConclusionThe combined anterosuperior malleolus dorsalis pedis flaps based on anterior tibial dorsalis pedis artery chain have reliable and sufficient blood supply. This area is a safe donor site that provides thin and sensate flaps for coverage of skin defect of the palm and dorsal aspects of the hand and the fingers.