踝管动脉穿支小腿皮瓣修复足部软组织缺损

张发惠; 谢昀; 张朝春; 林松庆; 郑和平

doi:10.13418/j.issn.1001-165x.2015.05.021

中国临床解剖学杂志 ›› 2015, Vol. 33 ›› Issue (5) : 581-583. DOI: 10.13418/j.issn.1001-165x.2015.05.021

临床研究

踝管动脉穿支小腿皮瓣修复足部软组织缺损

张发惠¹，　谢昀²，　张朝春¹，　林松庆¹，　郑和平¹

作者信息 +

Distally based tarsal tunnel arterial perforator flap for skin defects in foot

ZHANG Fa-hui¹，XIE yun², ZHANG Chao-chun¹, LIN Son-qing¹， ZHENG He-ping¹

Author information +

文章历史 +

摘要

目的总结踝管动脉穿支皮瓣修复足部的软组织缺损效果。方法在踝管动脉穿支解剖学研究的基础上，2005年6月至2013年6月间临床采用踝管动脉穿支皮瓣修复足部的软组织缺损36例，致伤原因：车祸伤24例，砸伤12例。损伤部位：足背14例，足内侧22例，软组织缺损范围为5 cm×3 cm~16.5 cm×10.0 cm。皮瓣切取面积最小为6.0 cm×4.0 cm，最大为本组皮瓣切取范围为7 cm×5 cm~18 cm ×12 cm，远端蒂旋转点位于平内踝。结果临床修复36例，创面Ⅰ期愈合33例，Ⅱ期愈合3例。所有病例经5~15个月随访，皮瓣色泽正常，外形与功能改善满意，供区创面植皮愈合良好，对功能无不良影响。结论踝管动脉穿支皮瓣，可以修复足部远侧创面，效果好。

Abstract

Objective　To summarize the clinical effects of repairing skin defects in foot by distally based tarsal tunnel arterial perforator flap.　Methods　Between June 2005 and June 2013, based on the anatomic study of arterial perforators of tarsal tunnel, thirty-six patients with soft-tissue defects in the foot underwent reconstruction with the distally based tarsal tunnel arterial perforator flap. The etiology of injury: twenty-four cases were caused by traffic accident, two by crashing objects. The defect locations were as follows: fourteen at the dorsal foot, twenty-two at the medial margin of foot. The defect size ranged from 5.0 cm×3.0 cm to 16.5 cm×10.0 cm. The smallest dimension of the flap was 6.0 cm×4.0 cm and the largest ranged from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm. The rotation point of the distal pedicle was at the medial malleolus. Results 33 of total 36 cases obtained primary healing, and the other 3 obtained secondary healing. Postoperative follow-ups of the patients ranged from 5 to 15 months. All flaps survived completely with good color, and the appearance and function were satisfying. The donor site healed without morbidity after reconstruction with skin-grafting.　Conclusion　The distally based tarsal tunnel arterial perforator s flap is an ideal option for repairing soft tissue defects of distal segment of foots．

导出引用

张发惠,谢昀,张朝春,林松庆,郑和平. 踝管动脉穿支小腿皮瓣修复足部软组织缺损[J]. 中国临床解剖学杂志. 2015, 33(5): 581-583 https://doi.org/10.13418/j.issn.1001-165x.2015.05.021

Distally based tarsal tunnel arterial perforator flap for skin defects in foot[J]. Chinese Journal of Clinical Anatomy. 2015, 33(5): 581-583 https://doi.org/10.13418/j.issn.1001-165x.2015.05.021

参考文献

[1] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerve:anatomic study and clinical experience in the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-1121.
[2] Cavadas PC. Reversed saphenous neurocutaneous island flap:clinical experience[J].Plast Reconstr Surg, 1997, 99(7):1940-1946.
[3] 潘云川, 王和驹, 柴益民, 等. 隐神经营养血管蒂逆行岛状皮瓣修复足踝部软组织缺损[J].中华整形烧伤外科杂志, 1999, 15(3):187-189.
[4] 周礼荣, 丁任, 蔡仁祥, 等. 四肢皮神经营养血管皮瓣的临床应用[J]. 中华显微外科杂志, 2000, 23(1):26-28.
[5] 文质君, 陈运祥, 钟世镇, 等. 小腿内侧逆行筋膜皮瓣修复足部创面的解剖研究及临床[J]. 中国临床解剖学杂志, 1994, 12(4):255-257.
[6] Amarente J, Costa H, Reis J, et al. A new distally based fasciocutaneous flap of leg[J]. Br J Plast Surg, 1986, 67:338-340.
[7] 陈运祥. 小腿内侧逆行筋膜蒂皮瓣修复足远端创面[J]. 中华整形烧伤外科杂志, 1991, 7(2):118.
[8] 戴松茂, 陆春才, 董仁章, 等. 小腿内侧逆行筋膜皮瓣的临床应用[J].中华显微外科杂志, 1989, 12(4):220-221.
[9] 徐辉铭, 王斌, 柴益民. 逆行小腿皮神经营养血管蒂筋膜岛状皮瓣的临床应用[J]. 解剖与临床, 2008, 13(5): 359-360.
[10]苏瑞鉴, 李文恒, 韦赤勇, 等. 带隐神经营养血管胫后动脉穿支蒂皮瓣的临床应用[J]. 解剖与临床, 2007, 12(6): 421-422.
[11]张发惠, 郑和平, 谢其扬, 等. 内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计[J]. 中国临床解剖学杂志, 2004, 22(6):568-572.
[12]张发惠, 郑和平.下肢皮神经—浅静脉营养血管远端蒂复合瓣的解剖学基础[J]. 解剖与临床, 2006, 12 (2):75-78.
[13]张发惠, 林松庆, 郑和平, 等. 以踝管区动脉穿支为蒂隐神经-大隐静脉营养血管皮瓣的显微解剖[J]. 解剖与临床, 2007, 12(6): 421-422.
[14]张发惠, 谢其扬, 郑和平, 等. 腓肠神经营养血管远端蒂皮瓣小隐静脉的应用解剖[J]. 中国修复重建外科杂志, 2005, 19(7): 505-507.