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,5 cases 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.
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