摘要
目的探讨在CT血管造影(CTA)辅助下,采用含足底内侧动脉穿支血管的筋膜岛状皮瓣修复足底负重区域软组织缺损的临床效果。方法回顾性分析潍坊市益都中心医院2011年5月至2019年10月采用含足底内侧动脉穿支血管的筋膜岛状皮瓣修复足底负重区域软组织缺损患者资料。患者术前均行足部CTA检查,通过计算机软件重建足底血管三维数字化模型,了解供区穿支解剖情况,设计与受区缺损形状、大小相适应的个性化修复方案。术后随访皮瓣修复效果、足部功能及感觉功能。采用配对样本t检验比较术前CTA与术中实际测量的穿支血管管径、足跟缘距穿支起始距离的差异。结果共纳入9例患者,其中男5例,女4例,年龄16~65岁,平均41岁。创面缺损范围为2.0 cm×2.0 cm~4.0 cm×5.0 cm,穿支筋膜皮瓣切取面积为6.0 cm×4.0 cm~12.0 cm×8.0 cm。术后9例皮瓣全部存活,随访半年~5年,皮瓣满意度评分达(8.7±3.1)分,患者均表示满意。足功能评分标准评定:优3例,良5例,中1例。周围神经损伤临床效果评价:感觉恢复达S4级3例,S3级5例,S2级1例;感觉恢复范围达R4级4例,R3级4例,R2级1例。术前测量的各穿支血管管径及足跟缘距穿支起始距离与术中实际测量结果比较,差异均无统计学意义(P>0.05)。结论含足底内侧动脉穿支血管的筋膜岛状皮瓣操作简单、安全、损伤小,是修复足底负重区域中、小范围软组织创面缺损的较好方式。
Objective To investigate the clinical effect of repairing soft-tissue defect of foot weight-bearing area with the help of CT angiography(CTA)using medial plantar artery perforator(MPAP)flap.Methods This was a retrospective study spanning over a period,from May 2011 to October 2019,conducted at the Yidu Central Hospital of Weifang.The data was focused on the cases of soft tissue defect in plantar bearing area repaired by fascial island skin flap containing a perforating branch of the medial plantar artery perforator.CTA of the foot was performed before procedure.The 3D digital model was reconstructed by computer software to explore the number,diameter,course,and distribution of perforating vessels in the donor site,and a personalized repair scheme was designed to match the shape and size of recipient site.The outcome of the flap repair,foot function,and sensory function were followed up.Pared-sample t-test was used to compare the difference of perforator vessel diameter and the distance from heel margin to perforator branch between preoperative and intraoperative actual measurement by CTA.Results A total of 9 patients were enrolled,including 5 males and 4 females.The mode for age group were 41(range,16-65 years).The area of the wound defect was 2.0 cm×2.0 cm-4.0 cm×5.0 cm,and the size of perforator fascial skin flap was 6.0 cm×4.0 cm-12.0 cm×8.0 cm.All the 9 flaps were survived and followed up for half a year to 5 years.All the patients were satisfied with the outcomes,the satisfaction score of flap efficacy was 8.7±3.1.Outcomes were evaluated according to the foot function scoring criteria:3 cases were excellent,5 cases were good,and 1 case was medium.Sensory recovery reached S4 in 3 cases,S3 in 5 cases,and S2 in 1 case.There were 4 cases in R4,4 cases in R3,and 1 case in R2.There was no significant difference between the preoperative measurement of perforator diameter and the distance between the heel edge and perforator(P>0.05).Conclusions The MPAP flap is simple,safe and easy to operate.It is one of the i
作者
常艳
王延玲
闫军美
李三亮
Chang Yan;Wang Yanling;Yan Junmei;Li Sanliang(Department of Hand and Foot Surgery,Yidu Central Hospital of Weifang,Weifang 262500,China;Pediatric Surgery,Yidu Central Hospital of Weifang,Weifang 262500,China;Department of Anesthesiology,Yidu Central Hospital of Weifang,Weifang 262500,China)
出处
《中华整形外科杂志》
CSCD
2021年第6期645-651,共7页
Chinese Journal of Plastic Surgery
关键词
血管造影术
穿支皮瓣
修复外科手术
足底
Angiography
Perforator flap
Reconstructive surgical procedures
Sole of foot
