CAJ | 학술논문

目的探讨穿支皮瓣修复跟周软组织缺损的疗效,并比较游离和带蒂穿支皮瓣的优缺点.方法 2009年1月至2011年12月共收治9例跟周软组织缺损患者,男5例,女4例;平均年龄为35.4岁(18 ～51岁).合并损伤:跟腱断裂或缺损3例,跟骨结节骨折、缺失4例,跟骨骨髓炎1例.缺损面积为4cm×1 cm～17cm×9cm,均采用穿支皮瓣覆盖创面,皮瓣面积为5cm×2cm～18cm×10 cm,其中游离穿支皮瓣5例(旋股外侧动脉降支穿支皮瓣3例,横支穿支皮瓣1例,胸背动脉穿支皮瓣1例),带蒂穿支皮瓣4例(腓动脉穿支皮瓣3例,胫后动脉穿支皮瓣1例).同时修补合并的跟腱断裂,术中复位内固定跟骨骨折. 结果 9例患者术后获6 ～ 39个月(平均21个月)随访.9例患者皮瓣完全存活,其中1例穿支皮瓣患者术后发生静脉危象,经探查存活;1例带蒂穿支皮瓣患者远端回流障碍,经持续按摩后存活.9例患者术后小腿肌力均达到5级.游离穿支皮瓣较带蒂穿支皮瓣厚,患者穿鞋时有后跟摩擦.1例患者术后1年随访时走路有轻度跛行,其余患者步态正常.结论对于小面积跟周软组织缺损者,应优先采用带蒂穿支皮瓣覆盖;对于缺损面积大、尤其是缺损宽度大的患者,应采用游离穿支皮瓣修复,并注意治疗并发的跟腱和跟骨损伤,以减少后遗症.
목적 탐토천지피판수복근주연조직결손적료효,병비교유리화대체천지피판적우결점.방법 2009년1월지2011년12월공수치9례근주연조직결손환자,남5례,녀4례;평균년령위35.4세(18 ～51세).합병손상:근건단렬혹결손3례,근골결절골절、결실4례,근골골수염1례.결손면적위4cm×1 cm～17cm×9cm,균채용천지피판복개창면,피판면적위5cm×2cm～18cm×10 cm,기중유리천지피판5례(선고외측동맥강지천지피판3례,횡지천지피판1례,흉배동맥천지피판1례),대체천지피판4례(비동맥천지피판3례,경후동맥천지피판1례).동시수보합병적근건단렬,술중복위내고정근골골절. 결과 9례환자술후획6 ～ 39개월(평균21개월)수방.9례환자피판완전존활,기중1례천지피판환자술후발생정맥위상,경탐사존활;1례대체천지피판환자원단회류장애,경지속안마후존활.9례환자술후소퇴기력균체도5급.유리천지피판교대체천지피판후,환자천혜시유후근마찰.1례환자술후1년수방시주로유경도파행,기여환자보태정상.결론 대우소면적근주연조직결손자,응우선채용대체천지피판복개;대우결손면적대、우기시결손관도대적환자,응채용유리천지피판수복,병주의치료병발적근건화근골손상,이감소후유증.
Objective To compare free perforator and pedicled perforator flaps in repair of soft tissue defects around the heel. Methods From January 2009 to December 2011,9 patients with soft tissue defects around the heel were treated in our center with perforator flaps.They were 5 men and 4 women,with an average age of 35.4 years (from 18 to 51 years).The concomitant injuries included Achilles tendon rupture or defect in 3 cases,calcaneus tubercle fracture or defect in 4 cases,and calcaneus osteomyelitis in one case.The defect sizes ranged from 4 cm × 1 cm to 17 cm × 9 cm.The perforator flaps ranged from 5 cm ×2 cm to 18 cm × 10 cm.There were 5 free perforator flaps (3 ones with the descending branch of the lateral circumflex femoral artery,one with the transverse branch of the lateral circumflex femoral artery and one with the thoracodorsal artery) and 4 pedicled perforator flaps (3 ones with the fibular artery and one with the posterior tibial artery).The concurrent Achilles tendon rupture was repaired and the calcaneus fracture reduced and internally fixated. Results The 9 patients were followed for 6 to 39 months (average,21months).All the flaps survived completely.One free perforator flap experienced postoperative vein congestion which was resolved after surgical exploration.One pedicled perforator flap had the problem of distal vein reflux but survived after continuous massage. The postoperative leg myodynamia reached level V in each case.Generally the free perforator flaps were thicker than the pedicled ones so that the patients with a thicker heel flap had a grinding feeling against the back collar of the shoe.All the patients regained a normal gait except one who had a cripple heel. Conclusions For small skin defects around the heel,pedicled perforator flaps may be the first choice while free perforator flaps are more suitable for large and wide skin defects around the heel.In any cases,the concurrent injuries to the Achilles tendon and the calcaneus should be repaired cautiously to minimize postoperative complications.