CAJ | 학술논문

目的探讨采用不携带腓肠神经和小隐静脉的腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损的可行性和临床效果. 方法 2009年1月至2013年8月,应用不携带腓肠神经和小隐静脉的腓动脉穿支螺旋桨皮瓣修复足踝部皮肤软组织缺损20例.以超声多普勒确定靠近创面的腓动脉穿支的穿出部位,以其为旋转点,以该点与腘窝中点至外踝与跟腱连线中点连线附近探及的第二穿支点连线为轴线,设计腓动脉穿支螺旋桨皮瓣,皮瓣切取不携带深筋膜、腓肠神经及小隐静脉,保留腓肠神经和小隐静脉周围的营养血管网于皮瓣内.皮瓣供区直接缝合.皮瓣切取面积7 cm×4 cm～21 cm×7 cm. 结果 20例皮瓣全部成活,创面一期愈合.术后随访10～28个月(平均13个月),皮瓣色泽、质地优良,皮瓣蒂部与供、受区外形满意,穿鞋不受影响,行走功能恢复正常.足外侧感觉与足部静脉回流无影响. 结论改良的腓动脉穿支螺旋桨皮瓣血供可靠,旋转方便,进一步减少了皮瓣供区损害,改善了皮瓣受区外观,可在临床推广应用.
목적 탐토채용불휴대비장신경화소은정맥적비동맥천지라선장피판수복족과부피부연조직결손적가행성화림상효과. 방법 2009년1월지2013년8월,응용불휴대비장신경화소은정맥적비동맥천지라선장피판수복족과부피부연조직결손20례.이초성다보륵학정고근창면적비동맥천지적천출부위,이기위선전점,이해점여객와중점지외과여근건련선중점련선부근탐급적제이천지점련선위축선,설계비동맥천지라선장피판,피판절취불휴대심근막、비장신경급소은정맥,보류비장신경화소은정맥주위적영양혈관망우피판내.피판공구직접봉합.피판절취면적7 cm×4 cm～21 cm×7 cm. 결과 20례피판전부성활,창면일기유합.술후수방10～28개월(평균13개월),피판색택、질지우량,피판체부여공、수구외형만의,천혜불수영향,행주공능회복정상.족외측감각여족부정맥회류무영향. 결론 개량적비동맥천지라선장피판혈공가고,선전방편,진일보감소료피판공구손해,개선료피판수구외관,가재림상추엄응용.
Objective To explore the feasibility and clinical effect of modified peroneal artery perforatorbased propeller flap which excludes small saphenous vein and sural nerve for coverage of the soft tissue defects of the ankle and foot.Methods From January,2009 to August,2013,20 patients with soft tissue defects of the foot or ankle underwent the procedures of reconstruction.After the proper perforators being identified with doppler sonography,the propeller flap was designed,which selected the location where terminal perforator vessels perforate deep fascia as the pivot point,the line from this point to the point where the second perforator near the wound around the line from the midpopliteal point to the midpoint of the achilles tendon and lateral malleolus perforated the deep facia as the axis.The flap was raised above the level of the deep fascia.The small extrinsic vessels around the sural nerve and small saphenous vein were contained in the flap,while the small saphenous vein and sural nerve were kept in the original position.The donor site was closed directly.The skin flaps measured from 7 cm × 4 cm to 21 cm × 7 cm.Results All 20 flaps survived completely without complications.During 10-28 months' followed-up (average 13 months),all flaps showed good texture matches and contour.All patients recovered walking and shoe wearing function.No one showed sensory disturbances at the lateral foot.Conclusion The modified peroneal artery perforator-based propeller flap excluding small saphenous vein and sural nerve still has stable blood supply,which is an idea way for covering skin and soft tissue defects in foot and ankle.