逆行胫后动脉穿支筋膜蒂皮瓣及逆行腓动脉穿支筋膜蒂皮瓣的临床疗效对比

发布时间：2018-04-19 06:31

本文选题：逆行腓动脉穿支筋膜蒂皮瓣 + 逆行胫后动脉穿支筋膜蒂皮瓣　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的:探讨逆行胫后动脉穿支筋膜蒂皮瓣及逆行腓动脉穿支筋膜蒂皮瓣对下肢踝部、小腿中下处皮肤缺损修复的疗效及并发症。对皮瓣存活率、并发症、皮瓣移植后下肢功能运动及供区的并发症进行比较,为临床上选用这两种皮瓣提供依据。方法:对2010-01至2015-01在本院使用逆行胫后动脉穿支筋膜蒂皮瓣修复下肢踝部、小腿中下处皮肤缺损患者52例、使用腓动脉穿支筋膜蒂皮瓣修复下肢踝部、小腿中下处皮肤缺损患者65例进行回顾研究,并将其分为胫后动脉组及腓动脉组。两组皮瓣均先探查穿支血管,再切取皮瓣。统计分析二组皮瓣的存活情况、并发症危险因素(如致病原因、皮瓣大小、瓣部宽度、旋转点等)、切取皮瓣时间及住院周期,并对二组患者进行半年以上随访,充分了解皮瓣结构功能、皮瓣外形满意度以及供区并发症。结果:腓动脉组一期存活率(84.6%)高于胫后动脉穿支组(57.69%),差异存在统计学上的意义(P0.05),腓动脉组与胫后动脉组相应皮瓣结构功能指标(如活动度、疼痛、穿鞋局限性、功能恢复情况)的评分不存在显著的差异(P0.05)。腓动脉穿支组增生性瘢痕、瘙痒、色素沉着、植皮区麻木、植皮区痛觉异常并发症发生率分别为(18.46、16.92、21.54、49.23、43.08),均显著低于胫后动脉穿支组(46.15、42.31、48.08、57.69、38.46),(增生性瘢痕、瘙痒、色素沉着差异有统计学意义P0.05,植皮区麻木、植皮区痛觉异常差异不存在统计学上的意义,P0.05)。结论:逆行腓动脉穿支皮瓣与逆行胫后动脉穿支皮瓣两者临床效果均得到验证,但是逆行腓动脉穿支筋膜皮瓣存活率高,并发症少,值得临床推广。
[Abstract]:Objective: to investigate the effect and complications of retrograde posterior tibial artery perforator fasciocutaneous flap and retrograde peroneal artery perforator fasciocutaneous flap in repairing the skin defect of lower extremity ankle and lower middle and lower leg.The survival rate, complications, lower limb movement and donor area complications after flap transplantation were compared, which provided the basis for clinical selection of the two kinds of flaps.Methods: from January 2010 to January 2015-01 in our hospital, 52 patients were treated with retrograde posterior tibial artery perforator fasciocutaneous flap to repair lower extremity malleolus and lower leg skin defect, and peroneal artery perforating fasciocutaneous flap was used to repair ankle of lower extremity.A retrospective study was carried out in 65 patients with skin defect in the middle and inferior part of the leg, and the patients were divided into posterior tibial artery group and peroneal artery group.In both groups, the perforating vessels were first explored, and then the flap was removed.The survival status, complication risk factors (such as the cause of disease, flap size, flap width, rotation point, etc.), the time of flap removal and the hospitalization period of the two groups were analyzed statistically, and the patients in both groups were followed up for more than half a year.To fully understand the flap structure and function, flap shape satisfaction and donor area complications.Results: the primary survival rate of peroneal artery group (84.6) was higher than that of posterior tibial artery perforator group (57.69%), and the difference was statistically significant (P 0.05). The corresponding flap structure and function indexes (such as movement, pain, shoe wearing limitation) in peroneal artery group and posterior tibial artery group were higher than those in posterior tibial artery group.There was no significant difference in the score of functional recovery (P 0.05).The incidences of hypertrophic scar, pruritus, pigmentation, numbness in skin grafts and abnormal pain perception in peroneal artery perforator group were 18.46 ~ 16.92 ~ 21.54 ~ 21.54 ~ 49.23 ~ 43.08, respectively, which were significantly lower than those in posterior tibial artery perforating branch group (46.15 ~ 42.31 ~ 48.087.67.69 ~ 38.46D) (hypertrophic scar, pruritus, pruritus)There was significant difference in pigmentation (P 0.05), numbness in skin grafting area, and no significant difference in dysmenia in skin graft area (P 0.05).Conclusion: the clinical effects of retrograde peroneal artery perforator flap and retrograde posterior tibial artery perforator flap are verified, but the retrograde peroneal artery perforator fascial flap has high survival rate and few complications, so it is worth popularizing clinically.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R658.3

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