以腓动脉终末支为蒂携带多个穿支血管的小腿外侧皮瓣修复幼儿足踝部大面积软组织缺损
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摘要
目的探讨以腓动脉终末支为蒂携带多个穿支血管的小腿外侧皮瓣修复幼儿足踝部大面积软组织缺损的临床效果。方法足踝部大面积软组织缺损患儿7例,年龄1~3岁,平均年龄2.3岁,以腓动脉走形为轴线切取小腿外侧皮瓣,均携带2~5支腓动脉穿支血管,远端蒂部解剖至腓动脉终末支近端周围,完全裸化其周边筋膜组织,皮瓣切取面积大小为5 cm×8 cm~6 cm×10 cm,供区创面一期腹部全厚皮打包加压。结果 6例皮瓣顺利成活,1例皮瓣远端约1.5 cm边缘坏死,经换药后愈合。术后随访3~12个月,平均7.5个月,皮瓣色泽、质地与周围组织接近,5例进行了二期皮瓣修整,其中3例行趾伸肌腱缺损修复重建术,术后患足功能和外形均满意。结论以腓动脉终末支为蒂携带多个穿支血管的小腿外侧皮瓣可以移位修复足踝部较大面积皮肤软组织缺损,血管解剖恒定,血运丰富,操作简单。
Objective To investigate the clinical effect of distally based lateral leg flap supplied by multiple perforator in reconstruction of large area soft tissue defects in foot and ankle. Methods 7 patients with large area of soft tissue defects in foot and ankle were treated by distally based lateral leg flap supplied by multiple perforator,aged from 1 to 3 years( mean 2. 3 years),and cut the lateral leg flap along the peroneal artery shape axis by carrying the 2 ~ 5 branch of peroneal artery perforator vessels,Anatomy distal pedicle to the peroneal artery branch proximal around and completely naked in the surrounding fascia tissue. Flaps were from 5 cm × 8 cm to 6 cm × 10 cm in size. Full-thickness skin grafts from the donor sites were packed and bandaged in first stage. Results In 6 cases flaps survived well,and 1 case had marginal necrosis with the area 1. 5 cm at the distal end of the flap. The follow-up time was 3 ~ 12 months,the average was 7. 5 months. The color and texture of the skin flap were close to the surrounding tissue,5cases underwent skin flap repair and three patients among them underwent reconstruction of extensor tendon defection in the second stage. The postoperative function and appearance were satisfactory. Conclusion Distally based lateral leg flap supplied by multiple perforator can repair the ankle in large area skin and soft tissue defect with constant vascular anatomy,rich blood supply and simple operation,which is an ideal operation way to repair infant foot and ankle tissue defect.
Objective To investigate the clinical effect of distally based lateral leg flap supplied by multiple perforator in reconstruction of large area soft tissue defects in foot and ankle. Methods 7 patients with large area of soft tissue defects in foot and ankle were treated by distally based lateral leg flap supplied by multiple perforator,aged from 1 to 3 years( mean 2. 3 years),and cut the lateral leg flap along the peroneal artery shape axis by carrying the 2 ~ 5 branch of peroneal artery perforator vessels,Anatomy distal pedicle to the peroneal artery branch proximal around and completely naked in the surrounding fascia tissue. Flaps were from 5 cm × 8 cm to 6 cm × 10 cm in size. Full-thickness skin grafts from the donor sites were packed and bandaged in first stage. Results In 6 cases flaps survived well,and 1 case had marginal necrosis with the area 1. 5 cm at the distal end of the flap. The follow-up time was 3 ~ 12 months,the average was 7. 5 months. The color and texture of the skin flap were close to the surrounding tissue,5cases underwent skin flap repair and three patients among them underwent reconstruction of extensor tendon defection in the second stage. The postoperative function and appearance were satisfactory. Conclusion Distally based lateral leg flap supplied by multiple perforator can repair the ankle in large area skin and soft tissue defect with constant vascular anatomy,rich blood supply and simple operation,which is an ideal operation way to repair infant foot and ankle tissue defect.
引文
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[4]Liu L,Liu Y,Zou L,et al.The distally based superficial sural flap for reconstruction of the foot and ankle in pediatric patients[J].J Reconstr Micro surg,2013,29(3):199-204.
[5]Tajsis N,Winkel R,Hoffmann R,et al.Sural perforator flap for reconstructive surgery in the lower leg and the foot:a clinical study of 86patients with post-traumatic osteomyelitis[J].J Plast Reconstr Aesthet Surg,2009,62(12):1701-1708.
[6]Baumeister SP,Spierer R,Erdmann D,et al.A realistic complication analysis of 70 sural aflery flaps in a muhimorbid patientgroup[J].Plast Reeonstr Surg,2003,112(1):129-140.
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[8]胡勇,李淑媛,孙文海,等.足踝部外伤皮肤缺损常用带蒂皮瓣的选择[J].中华显微外科杂志,2013,36(3):220-224.
[9]王先早,廖苏平,郑波,等.应用外踝上皮瓣修复足踝部皮肤缺损[J].临床外科杂志,2013,21(11):872-874.
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[11]裴飞舟,李志安,李振武,等.腓肠神经营养血管逆行皮瓣修复婴幼儿足踝部软组织缺损[J].中国骨与关节损伤杂志,2010,25(8):756-757.
[12]冯经旺,徐杰,冯运华,等.腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中华显微外科杂志,2011,34(3):232-234.
[13]宋力,幸超峰,熊颖杰,等.以腓动脉远端穿支血管供血为蒂的小腿后外侧(复合)组织瓣的临床应用[J].临床外科杂志,2011,19(2):129-13.
[14]宋力,幸超峰,沈立云,等.游离腓浅动脉单一穿支皮瓣移植修复前足中小皮肤软组织缺损[J].临床外科杂志,2014,22(1):129-131.
[15]徐胜.以腓动脉终末穿支为蒂的皮瓣应用解剖[J].中国临床解剖学杂志,1990,8(2):88-91.
[16]Rinker B,Valerio IL,Stewart DH,el al.Mierovascular free flap reconstruction in pediatric lower extremity trauma:a 10-year review[J].Plast Reconstr Surg,2005,115(6):1618-1624.
[17]慕卫东,李玉翠,丁小珩,等.幼儿腓肠神经营养血管皮瓣的解剖特点和临床应用[J].中国修复重建外科杂志,2007,21(8):904-905.
[18]王璋斌,董忠根,武文臣,等.儿童与成人腓动脉穿支筋膜蒂皮瓣修复小腿不同部位皮肤软组织缺损的疗效比较[J].中华创伤杂志,2016,32(9):823-828.
[2]Bullocks JM,Hickev RM,Basu CB,et al.Single-stage reconstruction of Achilles tendon injuries and distal lower extremity soft tissue defects with the reverse sural faseiocntaneous flap[J].J Plast Reeonstr Aesthet Surg,2008,61(5):566-572.
[3]Wei JW,Ni JD,Dong ZG,et al.Distally based perforator plus sural fasciocutaneous flap for reconstruction of complex soft tissue defects caused by motorcycle spoke injury in children[J].J Trauma Acute Care Surg.2012,73(4):1024-1027.
[4]Liu L,Liu Y,Zou L,et al.The distally based superficial sural flap for reconstruction of the foot and ankle in pediatric patients[J].J Reconstr Micro surg,2013,29(3):199-204.
[5]Tajsis N,Winkel R,Hoffmann R,et al.Sural perforator flap for reconstructive surgery in the lower leg and the foot:a clinical study of 86patients with post-traumatic osteomyelitis[J].J Plast Reconstr Aesthet Surg,2009,62(12):1701-1708.
[6]Baumeister SP,Spierer R,Erdmann D,et al.A realistic complication analysis of 70 sural aflery flaps in a muhimorbid patientgroup[J].Plast Reeonstr Surg,2003,112(1):129-140.
[7]Dai J,Chat Y,Wang C,et al.Comparative study of types of distally based sural neurocutaneous flap for reconstruction of lower leg,ankle,and heel[J].J Reconstr Microsurg,2013,29(2):125-30.
[8]胡勇,李淑媛,孙文海,等.足踝部外伤皮肤缺损常用带蒂皮瓣的选择[J].中华显微外科杂志,2013,36(3):220-224.
[9]王先早,廖苏平,郑波,等.应用外踝上皮瓣修复足踝部皮肤缺损[J].临床外科杂志,2013,21(11):872-874.
[10]付立策.小腿内侧皮瓣在足跟及踝部软组织缺损修复中的应用[J].中国实用医药,2013,8(6):49-50.
[11]裴飞舟,李志安,李振武,等.腓肠神经营养血管逆行皮瓣修复婴幼儿足踝部软组织缺损[J].中国骨与关节损伤杂志,2010,25(8):756-757.
[12]冯经旺,徐杰,冯运华,等.腓肠神经营养血管皮瓣修复足踝部软组织缺损[J].中华显微外科杂志,2011,34(3):232-234.
[13]宋力,幸超峰,熊颖杰,等.以腓动脉远端穿支血管供血为蒂的小腿后外侧(复合)组织瓣的临床应用[J].临床外科杂志,2011,19(2):129-13.
[14]宋力,幸超峰,沈立云,等.游离腓浅动脉单一穿支皮瓣移植修复前足中小皮肤软组织缺损[J].临床外科杂志,2014,22(1):129-131.
[15]徐胜.以腓动脉终末穿支为蒂的皮瓣应用解剖[J].中国临床解剖学杂志,1990,8(2):88-91.
[16]Rinker B,Valerio IL,Stewart DH,el al.Mierovascular free flap reconstruction in pediatric lower extremity trauma:a 10-year review[J].Plast Reconstr Surg,2005,115(6):1618-1624.
[17]慕卫东,李玉翠,丁小珩,等.幼儿腓肠神经营养血管皮瓣的解剖特点和临床应用[J].中国修复重建外科杂志,2007,21(8):904-905.
[18]王璋斌,董忠根,武文臣,等.儿童与成人腓动脉穿支筋膜蒂皮瓣修复小腿不同部位皮肤软组织缺损的疗效比较[J].中华创伤杂志,2016,32(9):823-828.