Clinical effects of lateral supramalleolar perforator island flaps with low rotation points in repairing foot skin and soft tissue defect wounds
-
摘要:
目的 探讨低位旋转点的外踝上穿支岛状皮瓣修复足部皮肤软组织缺损创面的临床效果。 方法 采用回顾性观察性研究方法。2017年10月—2020年8月，兰州大学第二医院收治14例足部皮肤软组织缺损创面患者，其中男6例、女8例，年龄14~77岁，包括足底皮肤肿瘤者4例、足底慢性溃疡者4例、足部交通伤者4例、足部深度烧伤残余创面者2例。肿瘤切除后或清创后创面面积为2.0 cm×2.0 cm~7.0 cm×5.0 cm，采用以外踝上穿支降支为蒂、旋转点位于外踝前下缘的岛状皮瓣进行修复。皮瓣面积为3.0 cm×2.0 cm~8.0 cm×6.0 cm，血管蒂长度为8.0~14.0 cm，皮瓣经皮下隧道转移修复创面。皮瓣供区创面采用大腿外侧中厚皮片修复。观察术后皮瓣成活情况、供受区创面愈合情况及并发症发生情况，随访观察皮瓣及其供区外形、足部功能。 结果 14例患者术后皮瓣均完全成活，供受区创面愈合良好，无血管危象、静脉淤血等发生。随访2~24个月，皮瓣外形较佳、不臃肿、耐磨，穿鞋、行走无影响；供区无明显瘢痕增生或色素沉着。 结论 以外踝上穿支降支为蒂、旋转点位于外踝前下缘的岛状皮瓣血运可靠，设计、操作简单，无须吻合血管，旋转点低、血管蒂长、旋转半径大，修复足部皮肤软组织缺损效果较佳。 Abstract:Objective To investigate the clinical effects of lateral supramalleolar perforator island flaps with low rotation points in repairing foot skin and soft tissue defect wounds. Methods The retrospective observational study was conducted. From October 2017 to August 2020, 14 patients (6 males and 8 females, aged 14-77 years) with foot skin and soft tissue defect wounds were admitted to Lanzhou University Second Hospital, including 4 cases of plantar skin tumor, 4 cases of chronic plantar ulcer, 4 cases of foot traffic injury, and 2 cases of residual wounds after deep foot burns. The wound size was 2.0 cm×2.0 cm to 7.0 cm×5.0 cm after tumor resection or debridement, which was repaired with island flap pedicled with the descending branch of the lateral supramalleolar perforator and the rotation point located at the lower front edge of the lateral ankle. The size of the flap ranged from 3.0 cm×2.0 cm to 8.0 cm×6.0 cm, and the length of vascular pedicle ranged from 8.0 to 14.0 cm. The flap was transferred by subcutaneous tunnel to repair the wound. The donor site wound of the flap was repaired with medium thickness skin graft from the lateral thigh. The survival of flaps, wound healing of the donor and recipient sites, and the occurrence of complications after operation were observed. The appearances of flaps and donor sites, and foot function were observed during follow-up. Results The flaps of 14 patients survived successfully after operation, and the wounds in the donor and recipient sites healed well, without vascular crisis, venous congestion, or other complications. Follow-up for 2 to 24 months showed that the flaps had good appearance without bloating and were wear-resistant, the functions of wearing shoes and walking were not affected, and there was no obvious scar hyperplasia or hyperpigmentation at the donor site. Conclusions With the descending branch of the lateral supramalleolar perforator as the pedicle and the rotation point located at the lower front edge of the lateral ankle, the island flap has a good effect in repairing the skin and soft tissue defect wound of the foot because of its reliable blood supply, simple design and operation, no need for vascular anastomosis, low rotation point, long vascular pedicle, and large radius of rotation. -
参考文献
(19) [1] LiL,SongD,ZhengH,et al.Anatomical basis of the reverse lateral plantar artery perforator flap design[J].Surg Radiol Anat,2015,37(8):983-988.DOI: 10.1007/s00276-015-1426-7. [2] 周荣,巨积辉,唐林峰,等.带感觉神经的股前外侧穿支皮瓣修复足底皮肤软组织缺损的临床效果[J].中华烧伤杂志,2021,37(5):453-459.DOI: 10.3760/cma.j.cn501120-20200309-00136. [3] LeeJT,ChengLF,HsuH,et al.Reconstruction of diabetic foot defects with the proximal lateral leg perforator flap[J].Ann Plast Surg,2019,82(5):546-551.DOI: 10.1097/SAP.0000000000001745. [4] 李攀登,沈国良.携带腓肠肌的腓动脉穿支腓肠神经营养血管双血供复合组织瓣修复足踝部腔隙性缺损的临床效果[J].中华烧伤杂志,2019,35(5):392-394.DOI: 10.3760/cma.j.issn.1009-2587.2019.05.013. [5] 王成德,王爱,孙继玲,等.三维CT血管造影辅助下游离腓动脉穿支皮瓣修复前足皮肤软组织缺损创面的临床效果[J].中华烧伤与创面修复杂志,2022,38(7):661-666.DOI: 10.3760/cma.j.cn501120-20210914-00317. [6] LeeJT,ChengLF,HsuH,et al.Reconstruction of diabetic foot defects with the proximal lateral leg perforator flap[J].Ann Plast Surg,2019,82(5):546-551.DOI: 10.1097/SAP.0000000000001745. [7] ZeidermanMR,PuLLQ.Contemporary approach to soft-tissue reconstruction of the lower extremity after trauma[J/OL].Burns Trauma,2021,9:tkab024[2022-09-23].https://pubmed.ncbi.nlm.nih.gov/34345630/.DOI: 10.1093/burnst/tkab024. [8] KhoongYM,HuangX,GuS,et al.Imaging for thinned perforator flap harvest: current status and future perspectives[J/OL].Burns Trauma,2021,9:tkab042[2022-09-23].https://pubmed.ncbi.nlm.nih.gov/34926708/.DOI: 10.1093/burnst/tkab042. [9] MasqueletAC,RomanaMC,WolfG.Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg[J].Plast Reconstr Surg,1992,89(6):1115-1121.DOI: 10.1097/00006534-199206000-00018. [10] 宋科,周明武,熊颖杰,等.旋转点下移的外踝上穿支皮瓣在修复前足软组织缺损的临床应用[J].中华显微外科杂志,2019,42(1):17-20.DOI: 10.3760/cma.j.issn.1001-2036.2019.01.006. [11] 黄伟雄,王明月,季鹏,等.改良外踝上皮瓣修复前足背皮肤软组织缺损[J].中华显微外科杂志,2015,38(4):401-403.DOI: 10.3760/cma.j.issn.1001-2036.2015.04.029. [12] 唐举玉,汪华侨,HallockGG,等.关注皮瓣供区问题—减少皮瓣供区损害专家共识[J].中华显微外科杂志,2018,41(1):3-5.DOI: 10.3760/cma.j.issn.1001-2036.2018.01.001. [13] KimK,KimJ,JeongW,et al.Outcome of distal lower leg reconstruction with the propeller perforator flap in diabetic patients[J].J Plast Surg Hand Surg,2021,55(4):242-248.DOI: 10.1080/2000656X.2020.1858843. [14] TeoTC.Propeller flaps for reconstruction around the foot and ankle[J].J Reconstr Microsurg,2021,37(1):22-31.DOI: 10.1055/s-0040-1715656. [15] BloughJT,Saint-CyrMH.Propeller flaps in lower extremity reconstruction[J].Clin Plast Surg,2021,48(2):173-181.DOI: 10.1016/j.cps.2021.01.002. [16] 路来金,彭维海,张舵,等.逆行外踝上筋膜皮瓣修复前足缺损的解剖学基础[J].中华显微外科杂志,2004,27(3):200-202.DOI: 10.3760/cma.j.issn.1001-2036.2004.03.014. [17] ParkTH,AnandA.Management of diabetic foot: brief synopsis for busy orthopedist[J].J Clin Orthop Trauma,2015,6(1):24-29.DOI: 10.1016/j.jcot.2014.10.003. [18] 侯春林,顾玉东.皮瓣外科学[M].2版.上海:上海科学技术出版社,2013:636-638. [19] TajsicN,WinkelR,HusumH.Distally based perforator flaps for reconstruction of post-traumatic defects of the lower leg and foot. A review of the anatomy and clinical outcomes[J].Injury,2014,45(3):469-477.DOI: 10.1016/j.injury.2013.09.003. -
下载:
图(2)
计量
- 文章访问数: 2181
- HTML全文浏览量: 62
- PDF下载量: 48
- 被引次数: 0
