CAJ | 학술논문

目的探讨游离腓动脉穿支皮瓣修复手足软组织缺损的方法和临床效果. 方法回顾性分析2010年7月至2012年12月应用游离腓动脉穿支动脉皮瓣修复的36例手足软组织缺损患者资料,男30例,女6例;年龄21 ～ 50岁,平均32.6岁.缺损部位:21例足部软组织缺损均为足背远端1/3皮肤缺损;15例手部软组织缺损中,8例手背皮肤缺损、肌腱外露,3例虎口皮肤软组织缺损,4例手掌皮肤缺损、肌腱外露.缺损面积为3.0cm×2.0cm～8.5 cm×4.0cm;皮瓣切取面积为4.0cm ×3.0 cm～ 10.0 cm×5.0 cm.受伤至手术时间为3～78 h,平均12.8h.其中29例以肌皮穿支动脉为蒂,7例以肌间隙穿支动脉为蒂.动脉血管蒂与受区采用端端或端侧吻合.末次随访时15例手部软组织缺损患者按中华医学会手外科学会上肢部分功能评定试用标准评定功能;21例足部软组织缺损患者按日本骨科学会(JOA)足部疾患治疗效果评定标准评定功能,36例患者采用英国医学研究会(BMRC)感觉功能评定标准评定皮瓣感觉功能. 结果 36例患者术后皮瓣全部成活.36例患者术后随访6～24个月,平均11个月.皮瓣无色素沉着,质地、外观及耐磨性良好.末次随访时15例手部软组织缺损患者按中华医学会手外科学会上肢部分功能评定试用标准评定:优12例,良2例,可1例;21例足部软组织缺损患者按JOA足部疾患治疗效果评定标准评定:评分为80 ～ 98分,平均90.6分;36例患者采用BMRC感觉功能评定标准评定皮瓣感觉功能恢复情况:25例为S3～S4,9例为S2,2例为S1.供区肢体均无瘢痕挛缩及功能障碍. 结论游离腓动脉穿支皮瓣的血管解剖恒定、皮瓣厚薄适中,不损伤下肢主要动脉,供区损伤小,可直接缝合或植皮,是修复手部及足背远端软组织中小面积缺损的有效方法.
목적 탐토유리비동맥천지피판수복수족연조직결손적방법화림상효과. 방법 회고성분석2010년7월지2012년12월응용유리비동맥천지동맥피판수복적36례수족연조직결손환자자료,남30례,녀6례;년령21 ～ 50세,평균32.6세.결손부위:21례족부연조직결손균위족배원단1/3피부결손;15례수부연조직결손중,8례수배피부결손、기건외로,3례호구피부연조직결손,4례수장피부결손、기건외로.결손면적위3.0cm×2.0cm～8.5 cm×4.0cm;피판절취면적위4.0cm ×3.0 cm～ 10.0 cm×5.0 cm.수상지수술시간위3～78 h,평균12.8h.기중29례이기피천지동맥위체,7례이기간극천지동맥위체.동맥혈관체여수구채용단단혹단측문합.말차수방시15례수부연조직결손환자안중화의학회수외과학회상지부분공능평정시용표준평정공능;21례족부연조직결손환자안일본골과학회(JOA)족부질환치료효과평정표준평정공능,36례환자채용영국의학연구회(BMRC)감각공능평정표준평정피판감각공능. 결과 36례환자술후피판전부성활.36례환자술후수방6～24개월,평균11개월.피판무색소침착,질지、외관급내마성량호.말차수방시15례수부연조직결손환자안중화의학회수외과학회상지부분공능평정시용표준평정:우12례,량2례,가1례;21례족부연조직결손환자안JOA족부질환치료효과평정표준평정:평분위80 ～ 98분,평균90.6분;36례환자채용BMRC감각공능평정표준평정피판감각공능회복정황:25례위S3～S4,9례위S2,2례위S1.공구지체균무반흔련축급공능장애. 결론 유리비동맥천지피판적혈관해부항정、피판후박괄중,불손상하지주요동맥,공구손상소,가직접봉합혹식피,시수복수부급족배원단연조직중소면적결손적유효방법.
Objective To explore the clinical effects of free flap pedicled with peroneal artery perforator in repair of soft tissue defects at hands and feet.Methods From July 2010 to December 2012,36 patients with soft tissue defects at hands and feet were repaired by free flaps pedicled with peroneal artery perforator.They were 30 men and 6 women,21 to 50 years of age (average,32.6 years).Twenty-one patients had skin defects at distal 1/3 dorsum of foot;of the 15 patients with hand soft tissue defects,8 had skin defects and tendon exposure at dorsum of hand,3 had skin defects between the thumb and the index finger,and 4 had skin defects and tendon exposure at the palm.The defective areas varied from 3.0 cm × 2.0 cm to 8.5 cm ×4.0 cm,the flap harvesting area varied from 4.0 cm × 3.0 cm to 10.0 cm × 5.0 cm.the time from injury to operation was from 3 to 78 hours (average,12.8 hours).Twenty-nine flaps were pedicled with intramuscular perforating branches,and 6 with intermuscular perforating branches.The blood vessels were anastomosed end to end.The function of affected limbs in the 15 cases of hand soft tissue defect was evaluated at the last follow-up according to the criteria by Hand Surgery Society,Chinese Medical Association (HSSCMA);the 21 patients with soft tissue defect of the feet was evaluated according to criteria by Japanese Orthopaedic Association (JOA);the functional recovery of skin sensation in the 36 patients was evaluated according to the criteria by British Medical Research Council (BMRC).Results All the transferred free flaps survived uneventfully.The 36 patients were followed up for 6 to 24 months (average,11 months).The flaps showed no pigmentation but fine texture,appearance,and wear-resistance.According to HSSCMA criteria,the function of affected limbs was excellent in 12 cases,good in 2 and fair in one.According to JOA criteria the 21 patients with soft tissue defect of the feet scored an average of 90.6 points (rang,from 80 to 98 points).According to BMRC criteria,the functional recovery of skin sensation was S3 to S4 in 25 cases,S2 in 9,and S1 in 2.The donor limbs showed no cicatricial contracture or dysfunction.Conclusions Free flaps pedicled with peroneal artery perforator are a good choice for repair of small or middle areas of soft tissue defect at hands and feet,because they are characterized by stable vascular anatomy,proper thickness,no damage to primary artery,slight injury to the donor site,and direct anastomosis.