CAJ | 학술논문

目的总结胫后动脉穿支隐神经营养血管双供血皮瓣修复小腿和足踝大面积软组织缺损的疗效. 方法 2006年1月至2012年2月,在多普勒血流仪引导下设计以胫后动脉穿支为旋转点,同时保留胫后动脉穿支及隐神经营养血管双供血的岛状皮瓣修复小腿、足踝部大面积皮肤软组织缺损20例.皮瓣面积为19 cm×11 cm～11 cm×8 cm.皮瓣切取范围上界可达髌骨上缘水平,皮瓣下界可达内踝上缘,前可至小腿前正中线,后可至小腿后正中线.皮瓣最远端可修复创面达趾跖关节. 结果 19例皮瓣完全成活,1例皮瓣远端部分坏死,二期再次行皮瓣修复后创面痊愈.所有病例均获随访,随访时间6～ 24个月,平均10个月.皮瓣色泽、血运、质地良好,无破溃.全部病例皮瓣不同程度恢复了痛觉与深触觉. 结论胫后动脉穿支隐神经营养血管双供血皮瓣不破坏胫后动脉主干血管,同时保留了胫后动脉穿支及隐神经营养血管双重供血来源,扩大了胫后动脉穿支的供血范围,使该皮瓣切取水平高,保证了皮瓣血液循环,可以修复小腿和踝足部大面积创面.
목적 총결경후동맥천지은신경영양혈관쌍공혈피판수복소퇴화족과대면적연조직결손적료효. 방법 2006년1월지2012년2월,재다보륵혈류의인도하설계이경후동맥천지위선전점,동시보류경후동맥천지급은신경영양혈관쌍공혈적도상피판수복소퇴、족과부대면적피부연조직결손20례.피판면적위19 cm×11 cm～11 cm×8 cm.피판절취범위상계가체빈골상연수평,피판하계가체내과상연,전가지소퇴전정중선,후가지소퇴후정중선.피판최원단가수복창면체지척관절. 결과 19례피판완전성활,1례피판원단부분배사,이기재차행피판수복후창면전유.소유병례균획수방,수방시간6～ 24개월,평균10개월.피판색택、혈운、질지량호,무파궤.전부병례피판불동정도회복료통각여심촉각. 결론 경후동맥천지은신경영양혈관쌍공혈피판불파배경후동맥주간혈관,동시보류료경후동맥천지급은신경영양혈관쌍중공혈래원,확대료경후동맥천지적공혈범위,사해피판절취수평고,보증료피판혈액순배,가이수복소퇴화과족부대면적창면.
Objective To summarize the curative effect of repairing large area soft tissue defects in heel and crus by flaps with double blood-supply of posterior tibial artery perforators and saphenous nerve nutrient vessels.Methods From January 2006 to February 2012,twenty cases took operation under the guide of Continuous Wave Doppler and design of tibial artery perforator as rotation point.And in all cases,island flaps with the blood supply from saphenous nerve nutrient vessels and tibial artery perforator were retained to repair large area soft tissue defects in heel and crus.In operations,the range of flap area were ranged from 19 cm × 11 cm to 11 cm × 8 cm.Skin flaps incision was up to the patella margin level,low to medial malleolus on edge,former to crus former median line,rear to after crus median line and farthest to the surface of wound on the metatarsophalangeal joint.Results Nineteen cases survived,and 1 case of skin flap mild necrosis at the farthest side took a second-phase line skin flap to repair.Followed-up from 6 months to 24 months was taken in all cases at the mean time of 10 months,with a result of good recovery and no ulceration for the flaps.To varying degree,all flaps recover sense of pain and deep touch.Conclusion There is no wound to posterior main tibial artery in repairing large area soft tissue defects in heel and crus by flaps with double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels,meanwhile to maintain double blood-supply from posterior tibial artery perforators and saphenous nerve nutrient vessels and expand the range of blood supply of posterior tibial artery perforators.In this operation,a blood circulation for the flap can be guaranteed so as for a large wound in heel and crus.