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

陈黎明; 王刚; 刘毅

doi:10.3760/cma.j.cn501120-20210630-00231

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

doi: 10.3760/cma.j.cn501120-20210630-00231

兰州大学第二医院烧伤整形与创面修复外科，兰州　　730030

基金项目:

全军医药卫生科研基金 BWS11C061

详细信息

通讯作者:
刘毅，Email：liuyi196402@163.com

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出版历程
- 收稿日期: 2021-06-30

Clinical effects of lateral supramalleolar perforator island flaps with low rotation points in repairing foot skin and soft tissue defect wounds

Department of Burns and Plastic SurgeryWound Repair Surgery, Lanzhou University Second Hospital, Lanzhou 730030, China

Funds:

Military Medical and Health Research Fund BWS11C061

More Information

Corresponding author: Liu Yi, Email: liuyi196402@163.com

摘要

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。
- 外科皮瓣 /
- 足损伤 /
- 软组织损伤 /
- 外踝上穿支皮瓣 /
- 创面修复 /
- 血管危象
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.
- Surgical flaps /
- Foot injuries /
- Soft tissue injuries /
- Lateral supramalleolar perforator flaps /
- Wound repair /
- Vascular crisis
陈黎明：酝酿和设计研究、实施手术、采集资料、分析数据及撰写论文；王刚：实施手术、采集资料、分析数据；刘毅：对文章的专业知识进行审阅、修改文章及指导

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1 用低位旋转点的外踝上穿支岛状皮瓣修复患者右足底慢性溃疡的效果。1A.入院时右足底第五跖骨基底腓侧创面；1B.将皮瓣旋转点设计在外踝前下缘，以外踝尖至腓骨小头连线向胫侧平移2 cm的线为轴线设计面积为3.5 cm×2.5 cm的皮瓣；1C.术中自外踝上方切开皮肤，暴露出外踝上穿支降支血管；1D.术中分离皮瓣；1E.皮瓣覆盖足底创面，供区用中厚皮片覆盖后即刻；1F.术后12 d，皮瓣及供区移植皮片存活良好

注：箭头指示外踝上穿支降支

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