中华显微外科杂志
中華顯微外科雜誌
중화현미외과잡지
Chinese Journal of Microsurgery
2015年
4期
359-362
,共4页
李涛%陈振兵%丛晓斌%艾方兴%周攀%洪光祥
李濤%陳振兵%叢曉斌%艾方興%週攀%洪光祥
리도%진진병%총효빈%애방흥%주반%홍광상
足%踝%穿支皮瓣%螺旋桨皮瓣%显微外科手术
足%踝%穿支皮瓣%螺鏇槳皮瓣%顯微外科手術
족%과%천지피판%라선장피판%현미외과수술
Foot%Ankle%Perforator flaps%Pedicled propeller flaps%Microsurgical operation
目的 探讨以多个穿支为共同血管蒂的小腿后、外侧“螺旋桨”皮瓣修复足、踝部皮肤缺损的方法及临床效果.方法 自2012年5月至2013年6月,共收治足、踝部皮肤缺损的患者8例,包括创伤导致皮肤、软组织缺损5例,慢性溃疡创面2例,关节囊肿破溃后感染引起皮肤坏死1例.以外踝与足跟之间发出的2～3个穿支血管为蒂,均采用小腿后、外侧2～3支穿支作为共同血管、以偏心蒂“螺旋桨”皮瓣的方式修复创面,皮瓣面积15.0 cm × 7.0 cm ～ 23.0 cm×9.0 cm,供区行游离植皮.术后行显微外科常规治疗及评价.结果 1例皮瓣远端出现宽2.0 cm、长1.0 cm大小的表层皮肤坏死,经换药表层脱痂,在1个月内自行愈合,其余7例皮瓣均完全成活.7例获得有效随访,随访时间7～18个月,平均10.7个月.患者对皮瓣外形满意度高,术后皮瓣感觉神经评级为S3级,患足AOFAS评分平均值为90.5,其中优3例,良4例.结论 以多个穿支为共同血管蒂增大了小腿后、外侧“螺旋桨”皮瓣的安全切取范围,能修复较远距离、较大创面的缺损,是一种安全有效的内增压术式.
目的 探討以多箇穿支為共同血管蒂的小腿後、外側“螺鏇槳”皮瓣脩複足、踝部皮膚缺損的方法及臨床效果.方法 自2012年5月至2013年6月,共收治足、踝部皮膚缺損的患者8例,包括創傷導緻皮膚、軟組織缺損5例,慢性潰瘍創麵2例,關節囊腫破潰後感染引起皮膚壞死1例.以外踝與足跟之間髮齣的2～3箇穿支血管為蒂,均採用小腿後、外側2～3支穿支作為共同血管、以偏心蒂“螺鏇槳”皮瓣的方式脩複創麵,皮瓣麵積15.0 cm × 7.0 cm ～ 23.0 cm×9.0 cm,供區行遊離植皮.術後行顯微外科常規治療及評價.結果 1例皮瓣遠耑齣現寬2.0 cm、長1.0 cm大小的錶層皮膚壞死,經換藥錶層脫痂,在1箇月內自行愈閤,其餘7例皮瓣均完全成活.7例穫得有效隨訪,隨訪時間7～18箇月,平均10.7箇月.患者對皮瓣外形滿意度高,術後皮瓣感覺神經評級為S3級,患足AOFAS評分平均值為90.5,其中優3例,良4例.結論 以多箇穿支為共同血管蒂增大瞭小腿後、外側“螺鏇槳”皮瓣的安全切取範圍,能脩複較遠距離、較大創麵的缺損,是一種安全有效的內增壓術式.
목적 탐토이다개천지위공동혈관체적소퇴후、외측“라선장”피판수복족、과부피부결손적방법급림상효과.방법 자2012년5월지2013년6월,공수치족、과부피부결손적환자8례,포괄창상도치피부、연조직결손5례,만성궤양창면2례,관절낭종파궤후감염인기피부배사1례.이외과여족근지간발출적2～3개천지혈관위체,균채용소퇴후、외측2～3지천지작위공동혈관、이편심체“라선장”피판적방식수복창면,피판면적15.0 cm × 7.0 cm ～ 23.0 cm×9.0 cm,공구행유리식피.술후행현미외과상규치료급평개.결과 1례피판원단출현관2.0 cm、장1.0 cm대소적표층피부배사,경환약표층탈가,재1개월내자행유합,기여7례피판균완전성활.7례획득유효수방,수방시간7～18개월,평균10.7개월.환자대피판외형만의도고,술후피판감각신경평급위S3급,환족AOFAS평분평균치위90.5,기중우3례,량4례.결론 이다개천지위공동혈관체증대료소퇴후、외측“라선장”피판적안전절취범위,능수복교원거리、교대창면적결손,시일충안전유효적내증압술식.
Objective To investigate the methods and results of lateral leg propeller pedicled flaps based on multi-perforators for coverage of soft-tissue defects on the foot and ankle.Methods From May,2012 to June,2013,8 patients with soft-tissue defects were treated,including 5 cases by trauma,2 cases by chronic unlcers,1 case by infection on the foot and ankle with exposed osseous and tendinous.Lateral leg propeller pedicled flaps based on multi-perforators were elevated and rotated with the angle from 150° to 180° for coverage of soft-tissue de-fects.Flap size ranged from 15.0 cm × 7.0 cm to 23.0 cm × 9.0 cm.Skin graft was applied to cover the donor sites.After the operation,the blood supplies of flaps were observed severely over 10 days.Questionnaire of the flap aesthetic satisfactory and AOFAS evaluation were performed in 7 patients during fellowed-up periods.Results Seven flaps were all survived well,1 flap had partial marginal skin necrosis on the distal,which was managed with surgical debridement,and wound healed in 1 month.Seven patients had a mean of 10.7 months' fellowed-up periods.The flaps had like-like appearance,good contour,and high aesthetic satisfactor (100％).The mean AOFAS score was 90.5.Conclusion Lateral leg propeller pedicled flaps based on multi-perforators can supply the blood of the larger volume of tissue,which can be safely sustained to repair distal and larger defects on the foot and ankle.
