摘要
目的探讨应用游离腓动脉穿支皮瓣修复足部小面积感染性溃疡并软组织缺损的手术方法及临床效果.方法2016年2月至2017年4月,应用游离腓动脉穿支皮瓣修复足部小面积感染性溃疡并软组织缺损创面9例.感染原因:外伤6例,糖尿病2例,脊髓损伤压疮1例.感染性溃疡部位:足底跖趾关节4例,跖趾关节背侧2例,第1跖趾关节内侧2例,足跟1例,皮瓣供区为同侧小腿.溃疡创面面积为3.0cm×2.0cm^5.0cm×3.0cm,皮瓣切取面积为4.0cm×3.5cm^7.0cm×4.5cm,供区创面直接缝合关闭.皮瓣带有腓肠外侧皮神经,术中与受区神经行端侧吻合,重建皮瓣感觉.所有患者均门诊随访.结果本组皮瓣全部成活,伤口均一期愈合,感染无复发.所有病例均获得随访,随访时间为6~24个月,平均16个月,皮瓣外形良好,质地、色泽接近受区,皮瓣感觉除糖尿病及脊髓损伤病例外均得到一定程度恢复.末次随访根据美国骨科足踝协会(AO-FAS)足功能评分(80.05±7.80)分,优5例,良2例,可2例.结论游离腓动脉穿支皮瓣具有血供可靠、穿支血管恒定、易于切取、供区损伤小、抗感染能力强及厚薄适中等优点,是修复足部小面积感染性溃疡并软组织缺损创面的有效方法.
Objective To investigate the clinical effect of infective foot ulcer and soft tissue defects of small area with free peroneal artery perforator flap.Methods From February,2016 to Apirl,2017,9 cases of infective foot ulcer and soft tissue defect of small area were repaired with peroneal artery perforator flap.Cause of infection:injury in 6 cases,diabetes in 2 cases,spinal cord injury subsequent pressure sore in 1 case.Infective ulcer part:4 cases on plantar metatarsophalangeal joint,2 cases on dorsal metatarsophalangeal joint,2 cases on interior of the first metatarsophalangeal joint and 1 case on the heel.Defect area:3.0 cm×2.0 cm-5.0 cm×3.0 cm;flap area:4.0 cm×3.5 cm-7.0 cm×4.5 cm.The donor sites were sutured directly.All the flaps contained lateral sural cutaneous nerve.In order to rebuild the sensation of flaps,nerves between surgical area and receiving area were received end-to-side anastomosis.Outpatient follow-up was used in all patients.Results All the flaps survived,and all the wounds were primary healed,without recurrence of infection.All patients were followed-up from 6 to 24 months with an average of 16 months.The appearance of flaps was good with slight bloated.The texture and color of the flaps were close to the recipient site.Flap feel was good except the cases of diabetes and spinal cord injury pressure sore.The AOFAS score at last follow-up time was 80.05±7.80,which was excellent in 5 cases,good in 2 cases,and fair in 2 cases.Conclusion The free peronerl artery perforator flap has many advantages,such as vascular anatomy constant,blood supply is reliable,thickness moderate,easy to get,strong resistance to infection,small district damage,etc.It is a useful clinical method to repair foot infection ulcer and soft issue defects of small area.
作者
胡雷鸣
欧学海
魏登科
李晓旭
Hu Leiming;Ou Xuehai;Wei Dengke;Li Xiaoxu(Department of hand surgery,Red Cross Hospital Affiliated to Xi'an Jiaotong University,Xi'an 710054,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2019年第3期246-249,共4页
Chinese Journal of Microsurgery
关键词
腓动脉穿支皮瓣
足部
感染性溃疡
修复
Peroneal atery perforator flap
Foot
Infective ulcer
Repair
