PTA穿支岛状皮瓣逆行修复腓骨长短肌腱外露及软组织缺损的研究
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摘要
目的探讨应用携带腓肠肌的胫后动脉(PTA)穿支岛状皮瓣逆行修复老年小腿外侧腓骨长短肌腱外露及软组织缺损的临床疗效。方法对20例老年腓骨长短肌腱外露及软组织缺损患者术前采用彩色多普勒血流成像(CDFI)检查胫前后动脉是否通畅。将患者分成两组,一组采用传统创面换药+PTA穿支岛状皮瓣逆行修复;另一组采用负压封闭引流(VSD)+PTA穿支岛状皮瓣逆行修复。比较两组患者术后感染率、住院时间、疼痛评分、抗生素使用时间等指标。结果随访6~18个月,穿支皮瓣全部成活,供区植皮愈合良好,其中VSD组踝关节功能评分(kofoed评分)为(95.0±5.6)分,住院时间平均为(14.0±4.4)d;对照组2例皮瓣边缘部分坏死,创口轻度感染,皮瓣不同程度臃肿,kofoed评分为(86.0±4.7)分,住院时间平均为(26.0±4.8)d。结论 PTA穿支岛状皮瓣VSD可以减少创面的感染率,缩短住院时间,获得更好的踝关节功能。
引文
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[11]廖湘波,梁正忠,王海龙,等.逆行骨间背侧动脉皮瓣转移治疗手背软组织缺损[J].临床骨科杂志,2013,16(4):405-407.
[12]蒋宾,丁淑蓉,赵杰清,等.负压封闭引流+氧气+臭氧在软组织缺损治疗中的应用[J].临床骨科杂志,2013,16(5):578-580.
[13]Zhang F,Zhang CC,Lin S,et al.Distally based saphenous nerve-great saphenous veno-fasciocutaneous compound flap with nutrient vessels:microdissection and clinical application[J].Ann Plast Surg,2009,63(1):81-88.
[14]吴攀峰,唐举玉,李康华,等.旋髂深动脉嵌合穿支皮瓣修复四肢骨和软组织缺损[J].中华显微外科杂志,2014,37(6):524-527.
[2]张全荣,芮永军,施海峰,等.胫后动脉穿支血管神经蒂皮瓣在足及小腿皮肤缺损的临床应用[J].中国矫形外科杂志,2013,21(18):1894-1897.
[3]Tanaka K,Matsumura H,Miyaki T,et al,An anatomic study of the intermusclar septum of the lower leg;branches from the posterior tibial artery and potential for reconstruction of the lower leg and the heel[J].J Plast Reconstr Aesthet Surg,2006,59(8):835-838.
[4]Hafeez K,Siddiqui A,Haroon-ur-Rashid,et al.The posterior tibial island flap for coverage in complex injuries of the lower extremity[J].Microsurgery,2012,32(7):539-545.
[5]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(3):308-311.
[6]文质君,陈运祥,钟世镇,等.小腿内侧逆行筋膜皮瓣修复足部创面的解剖研究及临床[J].中国临床解剖学杂志,1994,12(4):247-255.
[7]Ozdemir R,Kocer U,Sahin B,et al.Examination of the skin perforators of the posterior tibial artery of the leg and ankle region and their clinical use[J].Plast Reconstr Surg,2006,117(5):1619-1630.
[8]Drimoueas G,Kostopoulos E,Agiannidis C,et al.Redefining vascular anatomy of posterior tibial artery′s perforators:a cadaveric study and review of the literature[J].Ann Plast Surg,2016,76(6):705-712.
[9]Borrelli J,Prickett W,Song E,et al.Extraosseous blood supply of the tibia and the effects of different plating techniques:a human cadaveric study[J].J Orthop Trauma,2002,16(10):691-695.
[10]唐举玉,章伟文,张世民,等.中国特殊形式穿支皮瓣的名词术语与定义专家共识[J].中华显微外科杂志,2013,36(2):113-114.
[11]廖湘波,梁正忠,王海龙,等.逆行骨间背侧动脉皮瓣转移治疗手背软组织缺损[J].临床骨科杂志,2013,16(4):405-407.
[12]蒋宾,丁淑蓉,赵杰清,等.负压封闭引流+氧气+臭氧在软组织缺损治疗中的应用[J].临床骨科杂志,2013,16(5):578-580.
[13]Zhang F,Zhang CC,Lin S,et al.Distally based saphenous nerve-great saphenous veno-fasciocutaneous compound flap with nutrient vessels:microdissection and clinical application[J].Ann Plast Surg,2009,63(1):81-88.
[14]吴攀峰,唐举玉,李康华,等.旋髂深动脉嵌合穿支皮瓣修复四肢骨和软组织缺损[J].中华显微外科杂志,2014,37(6):524-527.