CAJ | 학술논문

目的探讨第1跖底动脉穿支皮瓣治疗(足母)趾软组织的临床效果. 方法根据第1跖底动脉穿支的走行、分支及其与(足母)展肌上缘动脉弓吻合的解剖学特点,以第1跖底动脉穿支浅出点为旋转点,以(足母)展肌上缘为皮瓣轴线在足内侧设计第1跖底动脉穿支皮瓣,移位修复(足母)趾皮肤软组织缺损患者17例,其中男11例,女6例;年龄14 ～ 69岁(平均36.5岁).致伤原因:重物压砸伤9例,交通伤6例,趾甲瓣移植后创面2例.损伤部位;足(足母)趾掌侧皮肤缺损3例,趾端皮肤缺损5例,足(足母)趾背侧皮肤缺损6例(含2例趾甲瓣移植后趾背缺损),足(足母)趾侧方皮肤缺损3例.缺损面积为3.0 cm×2.2 cm～7.5 cm×5.5 cm.皮瓣切取面积为3.2 cm×2.5 cm～11.0cm×4.5 cm.急诊手术Ⅰ期修复12例,择期手术Ⅱ期修复5例. 结果 17例皮瓣均成活,创面Ⅰ期愈合,经1 ～38个月随访,皮瓣质地优良、色泽接近正常、外形美观. 结论第1跖底动脉穿支皮瓣解剖位置恒定、血液供应良好、手术方法简单,是修复(足母)趾皮肤软组织缺损的可行方法之一.
목적 탐토제1척저동맥천지피판치료(족모)지연조직적림상효과. 방법 근거제1척저동맥천지적주행、분지급기여(족모)전기상연동맥궁문합적해부학특점,이제1척저동맥천지천출점위선전점,이(족모)전기상연위피판축선재족내측설계제1척저동맥천지피판,이위수복(족모)지피부연조직결손환자17례,기중남11례,녀6례;년령14 ～ 69세(평균36.5세).치상원인:중물압잡상9례,교통상6례,지갑판이식후창면2례.손상부위;족(족모)지장측피부결손3례,지단피부결손5례,족(족모)지배측피부결손6례(함2례지갑판이식후지배결손),족(족모)지측방피부결손3례.결손면적위3.0 cm×2.2 cm～7.5 cm×5.5 cm.피판절취면적위3.2 cm×2.5 cm～11.0cm×4.5 cm.급진수술Ⅰ기수복12례,택기수술Ⅱ기수복5례. 결과 17례피판균성활,창면Ⅰ기유합,경1 ～38개월수방,피판질지우량、색택접근정상、외형미관. 결론 제1척저동맥천지피판해부위치항정、혈액공응량호、수술방법간단,시수복(족모)지피부연조직결손적가행방법지일.
Objective To investigate the clinical effect of first plantar metatarsal artery perforator flap in repair of toe soft tissue defect.Methods According to the course and branches of the first plantar metatarsal artery and its anastomosing correlation with the artery arch of the superior margin of abductor hallucis,a plantar metatarsal artery perforator-based flap was designed to repair soft tissue defect around the hallux.Rotation point of the flap was upon the first metatarsophalangeal joint,and the superior margin of the abductor hallucis was designed as axis of the flap.There were 11 males and 6 females at age of 14-69 years (mean,36.5 years).Mechanism of injury was hit by heavy objects in 9 patients,traffic accidents in 2 and wounding after nail flap transplantation in 2.Skin defect located at the palmar toe in 3 patients,toe end in 5,dorsal toe in 6 and lateral toe in 3.Stage Ⅰ emergency surgery was performed in 12 patients and selective stage Ⅱ surgery in 5 patients.Size of defect ranged from 3.0 cm× 2.2 cm to 7.5 cm× 5.5 cm.Dimensions of the skin flap ranged from 3.2 cm × 2.5 cm to 11.0 cm× 4.5 cm.Results All the 17 flaps survived with primary wound healing.Texture,color and appearance of the flaps were satisfactory after a follow-up of 1-38 months.Conclusion With constant anatomic location,sufficient blood supply and easy surgical performance,the first plantar metatarsal artery perforator-based flap can be a good choice in repairing sofi tissue defect around the hallux.