收稿日期: 2016-05-20
网络出版日期: 2016-12-20
Repairing foot and ankle wounds by antegrade or retrograde posterior tibial artery perforator flap
Received date: 2016-05-20
Online published: 2016-12-20
目的 报道胫后动脉踝上穿支皮瓣修复足踝部创面的临床效果。 方法 对13例足踝部创面的患者，采用胫后动脉踝上穿支皮瓣转位修复术，其中足背创面5例，足跟部创面3例，踝部创面5例。4例急诊外伤创面伴有骨、肌腱外露者急诊修复。5例急诊创面采用VSD负压吸引后亚急诊行皮瓣修复， 4例为术后皮肤坏死，二期行皮瓣修复。皮肤缺损面积为1.5 cm×2.0 cm~7.0 cm×14.0 cm，切取皮瓣面积为2.5 cm×3.5 cm~8.0 cm×15.0 cm。 结果 本组13例皮瓣全部成活，供区植皮均成活。术后随访时间6~18个月，平均10个月。皮瓣质地接近周围皮肤，外观无臃肿。供区皮肤直接缝合者，术后瘢痕较小；供区植皮者，无明显瘢痕增生。踝关节活动良好，患肢均可负重行走。 结论 采用胫后动脉踝上穿支皮瓣转位修复足踝部创面，具有手术操作简单、安全的特点，是一种较好的术式。
陆治平 , 巨积辉 , 蒋国栋 , 陈建生 . 胫后动脉踝上穿支皮瓣修复足踝部创面[J]. 中国临床解剖学杂志, 2016 , 34(6) : 689 -692 . DOI: 10.13418/j.issn.1001-165x.2016.06.018
Objective To investigate the clinical effects of repairing foot and ankle wounds by the antegrade or retrograde posterior tibial artery perforator flap. Methods 13 cases with skin defects of foot and ankle were repaired using the antegrade or retrograde the posterior tibial artery perforator flap. 5 wounds were located in the dorsal aspect of the foot, 3 wounds located in the heel , and 5 wounds e located in the medial aspect. 4 defects with exposed bone or tendon underwent emergency operation of the posterior tibial artery perforator flap, 5 cases with no deep tissues exposure underwent emergent vacuum sealing drainage and a second stage flap surgery, and the other 4 cases with skin necrosis received a perforator flap coverage in second stage. The defects ranged from 1.5 cm×2.0 cm to 7.0 cm×14.0 cm. Antegrade or retrograde perforator flaps of posterior tibial artery with a size ranging from 2.5 cm×3.5 cm to 8.0 cm×15.0 cm were used to repair foot and ankle wounds. Results All flaps and skin grafts survived. The patients were followed up for 6 months to 18 months, with an average of 12months.The flap texture was similar to the normal skin with no significant bulky appearance. Scar was small at the direct suture skin donor sites and skin graft donor sites had no obvious scar. Good ankle flexion and extension, normal gait after operation were achieved. Conclusion the antegrade or retrograde posterior tibial artery perforator flap is a good method for repairing the foot and ankle wounds.
Key words： Foot and ankle; Sugical flaps; Soft tissue defect; Skin transplantation
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