Objective To explore the feasibility and therapeutic effect of thinned posterior tibial artery free perforator flap for the reconstruction of soft tissue defects at dorsum of hands.Methods Six fresh adult lower limbs specimens were injected with red latex via arterial cannula and dissected.The number,distribution,branches,and outer diameter of posterior tibia artery perforators were observed.Based on the anatomic study,the perforator flaps were designed to reconstruct soft tissue defects at dorsum of hands and wrists.The redundant fat on the flaps was removed,but preserving the nutrient vascular system.11 flaps were used with the size ranging from 2 cm × 5 cm to 10 cm × 14 cm.Results 43 skin perforators of posterior tibial artery were observed in six lower limbs,29 perforators with the outer diameter is greater than 0.5 mm when they threading over the deep fascia plane,on average every 4.8 bundles of sides.The mean outside diameter of perforating artery is (1.8 ± 0.5) mm,and the length is (44 ± 15)mm.6 perforators were founded both in the second and fifth zone which could be used for anastomosis for its better diameters.All flaps survived completely without any complication at donor sites.7 cases were followed up for 3-12 months.Both satisfactory functional and cosmetic results were achieved with a soft and thinned appearance.Conclusions The thinned posterior tibial artery free perforator flap has a reliable blood supply and good appearance.It is very suitable for the reconstruction of small or medium-sized defects at the dorsum of hands and wrists.%目的 探讨游离超薄型胫后动脉穿支皮瓣修复手部皮肤软组织缺损的可行性与临床效果.方法 用红色乳胶经股动脉灌注的6侧成人下肢标本,观测胫后动脉在小腿内侧的皮穿支数目、分布、分支、外径等指标.结合解剖学观察结果设计皮瓣,在切取穿支皮瓣后修剪掉多余的脂肪,保留皮瓣的营养血管系统,用来修复手背、腕背等创面.临床应用11例,皮瓣面积最大10 cm×14 cm,最小2 cm×5 cm.结果 在6侧标本中,观测到胫后动脉的皮肤穿支43条,穿深筋膜平面时外径≥0.5 mm者有29条,平均每侧4.8条.穿支血管起始点的平均外径为(1.8±0.5) mm,长度(44±15) mm,在小腿近端第2段、第5段内出现穿支各6条,口径较粗,可以提供吻合.所有皮瓣均完全成活,其中7例随访3 ～12个月,皮瓣质地柔软,外形不臃肿,供区无并发症,手部功能、外形均满意.结论 超薄型胫后动脉穿支皮瓣血供可靠、修复创面后外形美观,是一种修复手背部中、小面积软组织缺损的较好方法.
展开▼
