胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面
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摘要
目的探讨胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面的方法及疗效。方法 2014年9月—2017年8月,应用胫后动脉穿支远端蒂复合组织瓣修复12例小腿远端皮肤软组织缺损合并骨缺损。男8例,女4例;年龄25～66岁,平均41.3岁。致伤原因:交通事故伤7例,重物砸伤2例,胫骨骨髓炎并软组织溃疡、坏死2例,骨肿瘤切除术后骨和软组织缺损1例。8例一期修复,4例二期修复。皮瓣切取范围为6 cm×4 cm～10 cm×7 cm,肌瓣切取范围为4.0 cm×2.5 cm～8.0 cm×6.0 cm,骨瓣切取范围为4 cm×2 cm×2 cm～5 cm×4 cm×4 cm;供区胫骨骨缺损均采用自体髂骨植骨修复,创面直接拉拢缝合7例、部分缝合后游离植皮修复5例。结果术后12例胫后动脉穿支远端蒂复合组织瓣均成活,供、受区创面均Ⅰ期愈合。患者术后均获随访,随访时间6～12个月,平均10.8个月。复合组织瓣外观、颜色、质地及踝关节功能均满意。术后6个月X线片复查示骨瓣修复胫骨骨缺损处愈合良好,供区髂骨修复骨缺损处愈合良好。结论胫后动脉穿支远端蒂复合组织瓣血供丰富,是修复小腿远端局部软组织缺损合并局限性骨缺损创面的良好供区。
Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years(range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases,tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases.Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.
Objective To investigate the clinical application and effectiveness of the composite tissue flaps pedicled with perforating branch of posterior tibial artery for repairing distal leg defects. Methods Between September 2014 and August 2017, 12 patients with skin and bone defects of distal leg were repaired with the composite tissue flaps pedicled with perforating branch of posterior tibial artery. There were 8 males and 4 females with an average age of 41.3 years(range, 25-66 years). The causes of injury included traffic accident injury in 7 cases, heavy crushing injury in 2 cases,tibial osteomyelitis with soft tissue ulcer and necrosis in 2 cases, and bone and soft tissue defect after resection of bone tumor in 1 case. Eight patients underwent primary repair, and 4 patients underwent second-stage repair. The size ranged from 6 cm×4 cm to 10 cm×7 cm in skin flap, from 4.0 cm×2.5 cm to 8.0 cm×6.0 cm in muscle flap, and from 4 cm×2 cm×2 cm to 5 cm×4 cm×4 cm in tibial bone flap. Tibial defects of the donor region were repaired by autologous iliac bone grafting, and the wounds were sutured directly in 7 cases and repaired by autologous skin grafting in 5 cases.Results All composite tissue flaps survived and both the recipient and the donor wounds healed primarily. All patients were followed up 6-12 months, with an average of 10.8 months. The appearance, color, texture of the composite tissue flaps and ankle function were satisfactory. X-ray films showed that the bone flap at the tibia defect and the ilium graft at the donor site both healed well at 6 months after operation. Conclusion The composite tissue flaps pedicled with perforating branch of posterior tibial artery has abundant blood, and it is a good donor region for repairing the distal leg defects combined with circumscribed bone defect.
引文
1陶圣祥,喻爱喜,余国荣,等.腓肠神经营养血管肌皮瓣的解剖与临床应用.中华整形外科杂志, 2008, 24(1):16-19.
2唐举玉,魏在荣,张世民,等.穿支皮瓣的临床应用原则专家共识.中国临床解剖学杂志, 2016, 34(1):4-5.
3 赵治伟,刘文静,查朱青,等.带胫骨隐神经复合组织皮瓣在小腿创伤性骨与皮肤缺损中的临床应用.中国骨伤, 2017, 30(12):1131-1134.
4任高宏,任义军,王钢,等.组合皮瓣修复小腿及足踝部大面积软组织缺损.中华创伤骨科杂志, 2009, 11(11):1042-1046.
5张文龙,杜晓健,李冀,等.胫后动脉穿支皮瓣.中华解剖与临床杂志, 2017, 22(1):87-88.
6Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities(distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1):56-61.
7柳昊,叶澄宇,余国荣,等.胫后血管蒂小腿内侧复合组织瓣的临床应用.中国修复重建外科杂志, 2001, 15(3):147-149.
8倪玉龙.胫骨骨膜瓣的解剖学研究及临床应用.唐山:华北理工大学, 2016.
9Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands:Springer, 2015:228-232.
10孙文晋,陶圣祥,余国荣,等.远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用.中国临床解剖学杂志, 2012, 30(2):166-168.
11赵风林,李宗宝,王鑫,等.超薄型胫后动脉穿支皮瓣的解剖学观察与临床应用.中华整形外科杂志, 2013, 29(4):261-265.
12张天华,魏在荣.胫后动脉穿支皮瓣的解剖与临床研究进展.中国临床解剖学杂志, 2014, 32(2):231-233.
13Schaverien M, Saint-Cyr M. Perforators of the lower leg:analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1):161-170.
14Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg:anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3):793-801.
15柴益民,邱勋永,林崇正,等.胫后动脉穿支隐神经营养血管拟行皮瓣的临床应用.中华显微外科杂志, 2004, 27(2):99-100.
16 陶圣祥,喻爱喜,郑晓晖,等.隐神经营养血管复合组织瓣的解剖学研究.中华创伤骨科杂志, 2007, 9(3):248-250.
17黄凯,郭峭峰,林炳远,等.胫后动脉穿支蒂螺旋桨皮瓣联合植骨一期治疗胫骨远端创伤性骨髓炎.中华显微外科杂志, 2018,40(1):66-68.
18冯琼华,张远金,陶圣祥.逆行隐神经营养血管肌-皮-骨复合组织瓣转位术的临床应用.中国骨与关节损伤杂志, 2012, 27(9):862-863.
19 Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps:Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs,2017, 4(4):342-347.
20 余黎,余国荣,陶圣祥,等.小腿软组织缺损合并节段性骨缺损的显微外科修复.武汉大学学报(医学版), 2012, 33(5):705-707.
2唐举玉,魏在荣,张世民,等.穿支皮瓣的临床应用原则专家共识.中国临床解剖学杂志, 2016, 34(1):4-5.
3 赵治伟,刘文静,查朱青,等.带胫骨隐神经复合组织皮瓣在小腿创伤性骨与皮肤缺损中的临床应用.中国骨伤, 2017, 30(12):1131-1134.
4任高宏,任义军,王钢,等.组合皮瓣修复小腿及足踝部大面积软组织缺损.中华创伤骨科杂志, 2009, 11(11):1042-1046.
5张文龙,杜晓健,李冀,等.胫后动脉穿支皮瓣.中华解剖与临床杂志, 2017, 22(1):87-88.
6Bista N, Shrestha KM, Bhattachan CL, et al. The reverse sural fasciocutaneous flap for the coverage of soft tissue defect of lower extremities(distal 1/3 leg and foot). Nepal Med Coll J, 2013, 15(1):56-61.
7柳昊,叶澄宇,余国荣,等.胫后血管蒂小腿内侧复合组织瓣的临床应用.中国修复重建外科杂志, 2001, 15(3):147-149.
8倪玉龙.胫骨骨膜瓣的解剖学研究及临床应用.唐山:华北理工大学, 2016.
9Hou C, Chang S, Lin J, et al. Posterior tibial artery perforator flap//Surgical atlas of perforator flaps. Netherlands:Springer, 2015:228-232.
10孙文晋,陶圣祥,余国荣,等.远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用.中国临床解剖学杂志, 2012, 30(2):166-168.
11赵风林,李宗宝,王鑫,等.超薄型胫后动脉穿支皮瓣的解剖学观察与临床应用.中华整形外科杂志, 2013, 29(4):261-265.
12张天华,魏在荣.胫后动脉穿支皮瓣的解剖与临床研究进展.中国临床解剖学杂志, 2014, 32(2):231-233.
13Schaverien M, Saint-Cyr M. Perforators of the lower leg:analysis of perforator locations and clinical application for pedicled perforator flaps. Plast Reconstr Surg, 2008, 122(1):161-170.
14Heymans O, Verhelle N, Peters S. The medial adiposofascial flap of the leg:anatomical basis and clinical applications. Plast Reconstr Surg, 2005, 115(3):793-801.
15柴益民,邱勋永,林崇正,等.胫后动脉穿支隐神经营养血管拟行皮瓣的临床应用.中华显微外科杂志, 2004, 27(2):99-100.
16 陶圣祥,喻爱喜,郑晓晖,等.隐神经营养血管复合组织瓣的解剖学研究.中华创伤骨科杂志, 2007, 9(3):248-250.
17黄凯,郭峭峰,林炳远,等.胫后动脉穿支蒂螺旋桨皮瓣联合植骨一期治疗胫骨远端创伤性骨髓炎.中华显微外科杂志, 2018,40(1):66-68.
18冯琼华,张远金,陶圣祥.逆行隐神经营养血管肌-皮-骨复合组织瓣转位术的临床应用.中国骨与关节损伤杂志, 2012, 27(9):862-863.
19 Sahijwani H, Warikoo V, Salunke AA, et al. Anterior tibial artery perforator plus flaps:Role in coverage of posttumor excision defects around the knee joint and upper leg. Asia Pac J Oncol Nurs,2017, 4(4):342-347.
20 余黎,余国荣,陶圣祥,等.小腿软组织缺损合并节段性骨缺损的显微外科修复.武汉大学学报(医学版), 2012, 33(5):705-707.