游离穿支皮瓣联合游离植皮修复足踝部软组织缺损的疗效观察

发布时间：2018-02-26 02:01

本文关键词： 穿支皮瓣游离植皮足踝部软组织缺损封闭式负压引流　出处：《中国修复重建外科杂志》2017年03期 　论文类型：期刊论文

【摘要】：目的探讨应用游离穿支皮瓣结合游离植皮修复足踝部软组织缺损的临床效果。方法 2014年6月—2015年10月,收治20例足踝部软组织缺损患者。其中男16例,女4例;年龄19~61岁,平均43.3岁。致伤原因:交通事故伤7例,重物压砸伤9例,机器绞伤4例。创面部位:踝关节周围6例,足跟3例,足背4例,脱套伤截趾术后残端及前足底7例。创面范围15 cm×10 cm~27 cm×18 cm。受伤至手术时间11~52 d,平均27 d。采用游离穿支皮瓣联合游离植皮方法修复,其中股前外侧穿支皮瓣11例,腓肠内侧动脉穿支皮瓣4例,胸背动脉穿支皮瓣3例,腹壁下动脉穿支皮瓣1例,股前内侧动脉穿支皮瓣1例。其中采用嵌合穿支皮瓣5例,分叶穿支皮瓣5例,血流桥接穿支皮瓣3例(以血流桥接的方式将2个穿支皮瓣串联),联体穿支皮瓣3例。皮瓣切取范围10.0 cm×6.5 cm~36.0 cm×8.0 cm;皮片切取范围为5 cm×3 cm~18 cm×12 cm。结果术后18例皮瓣成活;2例出现静脉危象致皮瓣坏死,经对症处理后成活。其余患者皮瓣及植皮均成活,创面Ⅰ期愈合。供区切口Ⅰ期愈合。20例均获随访,随访时间4~18个月,平均8.3个月。受区无感染发生,皮瓣质地、颜色良好;足部恢复日常行走功能。供区仅遗留线性瘢痕。结论游离穿支皮瓣能修复足踝部任何区域,尤其是前足底负重区域创面,且供区损伤小,联合游离植皮是一种治疗足踝部软组织缺损的理想方法。
[Abstract]:Objective to investigate the clinical effect of free perforating branch flap combined with free skin graft in repairing soft tissue defect of foot and ankle. Methods from June 2014 to October 2015, 20 patients with soft tissue defect of foot and ankle were treated. The average age was 43.3 years old. The causes of injury were traffic accident in 7 cases, heavy object crush injury in 9 cases, mechanical wound in 4 cases. The wound site included 6 cases around ankle, 3 cases with heel, 4 cases with back of foot. There were 7 cases of stump and anterior plantar after toe amputation. The range of wound was 15 cm 脳 10 cm~27 cm 脳 18 cm 路cm. The time from injury to operation was 1152 days (mean 27 days). Free perforating branch flap combined with free skin graft was used to repair the wound, in which 11 cases were treated with anterolateral femoral perforating branch flap. There were 4 cases of perforating branch flap of medial sural artery, 3 cases of perforating branch flap of thoracic dorsal artery, 1 case of perforating branch flap of inferior abdominal artery and 1 case of perforating branch flap of anterior medial femoral artery. Blood flow bridging perforator flaps were performed in 3 cases (2 perforator flaps in series and conjoined perforator flaps in 3 cases by blood flow bridge). The range of flap was 10.0 cm 脳 6.5 cm~36.0 cm 脳 8.0 cm, and that of skin graft was 5 cm 脳 3 cm~18 cm 脳 12 cm. Results 18 cases of skin flap were developed after operation. The flap necrosis was caused by venous crisis in 2 cases. The skin flap and skin graft survived and the wound healed in the first stage. All the 20 cases were followed up for 4 ~ 18 months with an average of 8.3 months. There was no infection in the affected area, and the skin flap was of good texture and color. Conclusion the free perforating branch flap can repair any area of the ankle, especially in the front plantar bearing area, and the donor area injury is small. Combined free skin grafting is an ideal method for the treatment of soft tissue defects in ankle and foot.
【作者单位】：天津医院手显微外科;
【分类号】：R658.3

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