胫后动脉穿支皮瓣逆行修复老年腓骨长短肌腱外露及皮肤软组织缺损
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摘要
目的探讨应用胫后动脉穿支皮瓣逆行修复老年腓骨长短肌腱外露及皮肤软组织缺损临床效果。方法对12例老年腓骨长短肌腱外露及皮肤软组织缺损者应用胫后动脉穿支皮瓣逆行修复,术前采用超声多普勒血流探测仪检查胫前后动脉是否通畅,选择合适的胫后动脉穿支血管,设计并切取以该单一穿支为蒂的皮瓣,切取的皮瓣面积为12.0 cm×2.5 cm~15.0 cm×15.0 cm。结果患者均获得随访,时间6~18个月。穿支皮瓣全部成活,外形、色泽、质地、弹性良好;其中10例皮瓣与周围组织基本相平;2例皮瓣不同程度臃肿,经二期去脂整形后与周围组织相平。供区愈合良好。12例患者术后均可负重行走且无疼痛,皮瓣感觉功能为S3级及以上。结论胫后动脉穿支皮瓣修复老年腓骨长短肌腱外露及皮肤软组织缺损,皮瓣成活率高,供区影响小,是一种较为理想的方法。
Objective To investigate the clinical efficacy of repairing peroneus longus and brevis muscle tendons exposure and soft tissue defects in elderly patients by retrograde perforating flap of posterior tibial artery. Methods Twelve elderly patients with peroneal tendon exposure and skin soft tissue defects were treated by posterior tibial artery perforator flap. Blood flow of the anterior and posterior tibial artery were examined by color Doppler flow imaging,and an appropriate perforating flap of posterior tibial artery was designed and cut out. The size scope of flaps were 12. 0cm × 2. 5 cm ~ 15. 0 cm × 15. 0 cm. Results All cases were followed up for 6 ~ 18 months,all the flaps survived with a satisfied appearance and the color,quality,elasticity of the flaps were fine,the flaps were substantially as good as the surrounding tissue in 10 cases,while in the other 2 cases,the flaps were bloated of different degrees,after reshaping,they became as good as the surrounding tissue. The donor sites healed well. All the 12 patients could tolerate weight-bearing walking without postoperative pain. Besides,sensory function of all flaps were at least S3 degree. Conclusions For elderly patients with peroneus longus and brevis muscle tendons exposure and soft tissue defects,this flap is an ideal solution which has a high survival rate and little effect on the donor sites.
Objective To investigate the clinical efficacy of repairing peroneus longus and brevis muscle tendons exposure and soft tissue defects in elderly patients by retrograde perforating flap of posterior tibial artery. Methods Twelve elderly patients with peroneal tendon exposure and skin soft tissue defects were treated by posterior tibial artery perforator flap. Blood flow of the anterior and posterior tibial artery were examined by color Doppler flow imaging,and an appropriate perforating flap of posterior tibial artery was designed and cut out. The size scope of flaps were 12. 0cm × 2. 5 cm ~ 15. 0 cm × 15. 0 cm. Results All cases were followed up for 6 ~ 18 months,all the flaps survived with a satisfied appearance and the color,quality,elasticity of the flaps were fine,the flaps were substantially as good as the surrounding tissue in 10 cases,while in the other 2 cases,the flaps were bloated of different degrees,after reshaping,they became as good as the surrounding tissue. The donor sites healed well. All the 12 patients could tolerate weight-bearing walking without postoperative pain. Besides,sensory function of all flaps were at least S3 degree. Conclusions For elderly patients with peroneus longus and brevis muscle tendons exposure and soft tissue defects,this flap is an ideal solution which has a high survival rate and little effect on the donor sites.
引文
[1]庞水发,常湘珍,张方晨,等.皮瓣移植临床应用应坚持原则[J].中华显微外科杂志,2010,33(2):1-2.
[2]Hafeez K,Siddiqui A,Rashid H U,et al.The posterior tibial island flap for coverage in complex injuries of the lower extremity[J].Microsurgery,2012,32(7):539-545.
[3]徐永清,范新宇.小腿穿支皮瓣的临床应用[J].中华显微外科杂志,2013,36(4):308-311.
[2]Hafeez K,Siddiqui A,Rashid H U,et al.The posterior tibial island flap for coverage in complex injuries of the lower extremity[J].Microsurgery,2012,32(7):539-545.
[3]徐永清,范新宇.小腿穿支皮瓣的临床应用[J].中华显微外科杂志,2013,36(4):308-311.