目的 探讨术前B超辅助定位设计小腿穿支螺旋桨皮瓣移植修复小腿远端及足踝部软组织缺损的临床疗效。 方法 回顾性分析本院2012年1月~2017年10月收治的46例小腿远端及足踝部软组织缺损患者临床资料：男33例，女13例；年龄27~68岁，平均48.2岁，缺损面积21 cm×8 cm~8.5 cm× 5.5 cm。患者均为二期修复，修复时间为伤后5~42 d，均采用小腿穿支螺旋桨皮瓣完成修复，胫后动脉穿支蒂31例，腓动脉穿支蒂15例。术前采用彩色多普勒超声（color doppler ultrasound，CDS）对穿支进行定位，根据穿支及创面情况设计皮瓣。术中验证穿支定位准确性，术后对皮瓣成活率、并发症及皮瓣7项指标进行疗效评价。 结果 术中见定位符合率达89.1%；定位误差＞1 cm的有5例，其中1例皮瓣术后完全坏死，4例皮瓣远端部分坏死。34例供区切口直接缝合；12例供区植皮，2例植皮出现部分坏死感染，其余供区愈合良好。本组有1例患者术后皮瓣周围感染伤口不愈合，2例供区植皮少部分坏死。术后3例失访，43例患者获得5~46个月随访（平均14.3个月），按皮瓣功能7项指标评定，优14例，良23例，可3例，差3例，优良率为86.0%。 结论 术前CDS定位的小腿穿支螺旋桨皮瓣修复小腿远端及足踝部创面效果良好，外观满意，临床实用性较高。
Abstract
Objective To assess clinical efficacy of perforators positioning technique in perforator pedicled propeller flap of the leg reconstructing soft tissue defects of distal termination of leg and around the foot and ankle. Methods Forty-six patients with soft-tissue defects in distal termination of leg and around the foot and ankle (33 males and 13 females, aged from 27 to 68 years with an average of 48.2 ) were collected to our hospital from January of 2013 to August of 2017 and were analyzed retrospectively. The defect areas was 21 cm×8 cm~8.5 cm×5.5 cm. All the patients underwent secondary repair and the repair time was 5 days~42 days after injury. Preoperative perforator positioning of the flap through the method of color doppler ultrasound(CDS) was performed. Thirty-one cases of posterior tibial artery perforators and 15 cases of radial artery perforators were included. Preoperative color doppler ultrasound was used to locate the perforator branch, and the skin flap was designed according to the perforator branch and the wound surface. The accuracy of perforator branch positioning was verified during the operation. Postoperative survival rate, complications and seven indicators of skin flap were evaluated. Results The coincidence rate was 89.1% during the operation. One case had complete necrosis after flap operation and 4 cases of anterolateral thigh perforator flaps distal partial necrosed. Thirty-four patients were sutured directly through donor incision. Twelve donor sites were skin grafted, 2 patients had partial necrosis of skin grafts, and the other donor sites healed well. In this group, one patient did not heal the infected wound around the skin flap after surgery, and two patients had a small part of skin graft necrosis in the donor site. Forty-three patients were followed up ranged 5 to 46 months (average of 14.3 months). According to the evaluation 7 indicators of skin flap function, 14 cases were excellent, 23 cases were good , 3 cases were fair, and 3 cases were poor , with an excellent and good rate of 86.0%. Conclusions The preoperative color Doppler ultrasound localized perforator pedicled propeller flaps have good effect on repairing the wound of the distal leg and around the foot and ankle, with satisfactory appearance and high clinical practicality.
关键词
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穿支皮瓣； 螺旋桨； 多普勒； 显微外科
Key words
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Perforator flap； Propeller； Doppler； Microsurgery
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参考文献
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基金
江苏省卫生计生委面上项目（H2017077）；“无锡市太湖人才计划”顶尖医学团队（2020）
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