小腿穿支皮瓣修复踝周皮肤软组织缺损

摘要

目的 探讨小腿穿支血管皮瓣修复踝周皮肤软组织缺损的应用价值. 方法 2007年1月至2012年12月,应用不同类型的小腿穿支皮瓣逆行转移修复踝周皮肤软组织缺损62例,均合并肌腱和(或)骨外露,其中7例跟腱断裂术后外露或窦道形成,8例合并踝关节、跗骨间关节破损外露,24例伴胫骨远端、内踝、外踝、跟骨骨折,11例合并不同程度感染.一期修复15例,延期或二期修复47例.胫后动脉内踝上穿支皮瓣10例,腓动脉外踝上前穿支皮瓣12例,腓动脉外踝上后穿支皮瓣40例;皮瓣切取面积为4.0 cm×5.5 cm～9.0 cm×15.0 cm.供区直接缝合10例,余采用植皮修复创面. 结果 术后56例皮瓣完全成活,3例腓动脉外踝上前穿支皮瓣、1例胫后动脉内踝上前穿支皮瓣、2例腓动脉外踝上后穿支皮瓣出现远端部分坏死,经换药后痊愈;所有病例经随访3～12个月,皮瓣质地柔软、弹性好.供区植皮全部成活. 结论 小腿穿支皮瓣修复踝周皮肤软组织缺损具有手术操作简单、不损伤主干血管、皮瓣成活可靠、供区破坏少等优点,针对不同部位进行“个性化”皮瓣选择非常重要.%Objective To explore the application value of the lower leg perforator flaps in repairing soft tissue defect on ankle.Methods From January 2007 to December 2012,62 cases of soft tissue defect on ankles have been repaired.The defects were combined with tendon and/or bone exposure for all the cases,among them 7 cases were exposure or sinus tract after achilles tendon rupture surgery,8 cases with ankle or intertarsal joint defect and exposure,24 cases with distal tibia fracture,or medial malleolus fracture,or lateral malleolus fracture,or calcaneus fracture,11 cases with different level of infection.Fifteen cases were primarily repair,and 47 cases were secondly repair or extended phase.The cases were repaired by applying different types retrograde transferred perforator pedicle flaps of lower legs,with 10 cases of posterior tibial artery perforator flaps on the medial malleolus,12 cases of front top flaps of com peroneal artery on external ankle,40 cases of back top flaps of peroneal artery on external ankle.The sizes of the flap ranged from 4.0 cm ×5.5 cm to 9.0 cm × 15.0 cm.Ten cases were applied direct suturing in donor site,and other cases were applied skin grafts to repair the defect.Results Flaps in 56 cases completely survived.Partial necrosis appeared in 3 cases of front top flaps of peroneal artery on external ankle,one perforator flap of posterior tibial artery on the medial malleolus and 2 cases of back top flaps of peroneal artery on external ankle.All these cases recovered after careful dressing changes.Sixty two cases were followed up for 3-12 months.Texture of flaps was soft with good elasticity.All of the donor skin grafts in patients survived.Conclusion Perforator flaps have the advantage of easy operation,little damage to the main blood vessels,high reliability in flap survival,less destroy to donor site.It is important that individualized flap is selected given different position of defect.