应用优化腓动脉低位穿支螺旋桨皮瓣修复足踝、足跟后外侧创面

摘要

目的 探讨腓动脉低位穿支螺旋桨皮瓣的优化设计以及修复足踝、足跟后外侧创面的临床应用效果.方法 2009年1月至2016年3月,对28例足踝、足跟后外侧皮肤软组织缺损患者进行修复,其中车祸伤15例,压砸伤8例,绞伤3例,电击伤2例,创面大小3 cm×3 cm～4 cm×6 cm.均采用腓动脉低位穿支螺旋桨皮瓣带蒂转移修复,将腓骨头至外踝尖端等分为9段,在第6～9段范围内用多普勒超声定位腓动脉低位穿支,以穿支穿出点为旋转点,以腓动脉穿支走行为皮瓣的中轴线.设计螺旋桨皮瓣时对大桨长宽比进行优化,将旋转点至创面远端距离作为大桨的长度,皮瓣宽度为大桨长度的一半,确保皮瓣大桨的长、宽比不超过2∶1,根据创面形状调整皮瓣形状,切取皮瓣大小3 cm×5 cm～4 cm×10 cm,将皮瓣旋转180°,大桨覆盖创面及小桨供区,小桨修复大桨供区.结果 1例皮瓣因静脉危象部分坏死,经过换药后愈合,其余27例皮瓣全部成活,随访6 ～24个月,皮瓣色泽好,无瘢痕挛缩,皮瓣不臃肿,无需再次手术修整.结论 经优化后的腓动脉低位穿支螺旋桨皮瓣,可以避免皮瓣远端坏死,是修复足踝、足跟后外侧创面的理想皮瓣之一.%Objective To investigate the therapeutic effect of propeller flap with low peroneal artery perforator for defects at ankle and heel.Methods From January 2009 to March 2016,28 cases with skin defects at ankle and heel were treated with propeller flap pedicled by low peroneal artery perforator,including 15 cases of car accidents,8 cases of pressure injury,3 cases of wring injury and 2 cases of electricity shock injury.Defects size ranged from 3 cm × 3 cm to 4 cm × 6 cm.The fibular was divided into 9 segments from head to external ankle.Doppler ultrasound was used to locate the low peroneal artery perforator from the lower 6-9 segments.The flap pivot point was at perforator point at skin surface,with the peroneal artery as flap axis.The length of big blade was the distance from rotate point to distal end of defects.The flap width was half of the length.The ratio of big blade length to width should not exceed 2∶ 1.The flaps size was from 3 cm × 5 cm to 4 cm × 10 cm,based on the defect size.The defects at donor site could be closed with small blade directly.Results Partial necrosis happened in 1 case due to veneous crisis,which healed after dressing.All the other 27 flaps survived completely.During the follow-up period,the flaps had good match in color and thickness.No secondary operation was needed.Conclusions The optimization of propeller flap with low peroneal artery perforator is an idealmethod for defects at ankle and heel,which can avoid the necrosis at distal end of flap.