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

王成德; 王爱; 孙继玲; 马文国; 王建国

doi:10.3760/cma.j.cn501120-20210914-00317

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

doi: 10.3760/cma.j.cn501120-20210914-00317

1.
潍坊市益都中心医院介入治疗科，潍坊　　262550
2.
潍坊市益都中心医院烧伤整形外科，潍坊　　262550
3.
潍坊市益都中心医院示教室，潍坊　　262550
4.
青州市中医院骨科，潍坊　　262500

基金项目:

潍坊市卫生健康委员会科研项目 wfwsjk_2019_145

详细信息

通讯作者:
王建国，Email：wjg3389@126.com

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出版历程
- 收稿日期: 2021-09-14

Clinical effects of free peroneal artery perforator flaps in repairing forefoot skin and soft tissue defect wounds assisted with three-dimensional computed tomography angiography

1.
Interventional Therapy Department, Yidu Central Hospital of Weifang, Weifang 262550, China
2.
Department of Burn and Plastic Surgery, Yidu Central Hospital of Weifang, Weifang 262550, China
3.
Demonstration Classroom, Yidu Central Hospital of Weifang, Weifang 262550, China
4.
Orthopaedic Department, Chinese Medicine Hospital of Qingzhou City, Weifang 262500, China

Funds:

Scientific Research Program of Health Commission of Weifang City wfwsjk_2019_145

More Information

Corresponding author: Wang Jianguo, Email: wjg3389@126.com

摘要

摘要: 目的探讨在三维CT血管造影（3D-CTA）辅助下采用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疗效。方法采用回顾性观察性研究方法。2017年3月—2019年9月，潍坊市益都中心医院烧伤整形外科收治15例前足皮肤软组织缺损创面患者，其中男12例、女3例，年龄18~60岁。入院时创面面积为3.0 cm×3.0 cm~9.0 cm×8.0 cm。术前行3D-CTA检查，选择血管蒂长度合适、血流灌注好的腓动脉穿支血管。根据创面面积及3D-CTA检查定位的腓动脉穿支血管情况，设计及切取大小为3.5 cm×3.5 cm~9.5 cm×8.5 cm腓动脉穿支皮瓣，皮瓣携带腓肠外侧皮神经并与创面的神经吻合。供区创面直接拉拢缝合或取大腿中厚皮覆盖。观察术前3D-CTA检查拟切取的腓动脉穿支血管类型、管径、穿出位置与术中实际探测情况是否一致，记录皮瓣切取时长和术后皮瓣成活情况。术后12个月随访，指导患者按照Maryland足功能评分标准评定足部功能，观察供区创面愈合情况及影响肢体运动功能的并发症发生情况。对数据行配对样本t检验。结果该组患者术中探测到拟切取的腓动脉穿支血管类型为肌间隔穿支者12例、肌皮穿支者2例、肌肉-肌间隔穿支者1例，与术前3D-CTA检查结果一致。术前3D-CTA测量的腓动脉穿支血管管径为（1.38±0.17）mm，与术中测量的（1.40±0.19）mm相近（t=0.30，P>0.05）；术前3D-CTA测量的穿支起始点至小腿外缘水平距离为（42±6）mm，穿支起始点至外踝尖水平的垂直距离为（219±14）mm，分别与术中测量的（43±6）、（221±15）mm相近（t值分别为0.46、0.38，P>0.05）。皮瓣切取时长为（31±6）min，术后皮瓣全部成活，无血管危象出现。术后12个月随访，足功能评定为优者11例、良者3例、中者1例；供区创面愈合良好，瘢痕不明显，无挛缩，肢体运动功能无影响。结论游离腓动脉穿支皮瓣是重建前足皮肤软组织缺损创面的有效方法之一，术前3D-CTA明确了穿支血管解剖位置，降低了手术风险。
- 伤口愈合 /
- 穿支皮瓣 /
- 血管造影术 /
- 足前段，人
Abstract: Objective To investigate the clinical effects of free peroneal artery perforator flaps in repairing forefoot skin and soft tissue defect wounds assisted with three-dimensional computed tomography angiography (3D-CTA). Methods A retrospective observational study was conducted. From March 2017 to September 2019, 15 patients with skin and soft tissue defect wounds in the forefoot were treated in the Department of Burn and Plastic Surgery of Yidu Central Hospital of Weifang, including 12 males and 3 females, with age of 18-60 years. The wound area on admission was 3.0 cm×3.0 cm-9.0 cm×8.0 cm. The 3D-CTA examination before operation was performed to select the peroneal artery perforating vessels with appropriate length of vascular pedicle and good blood perfusion. According to the wound area and the perforating vessels of the peroneal artery located by 3D-CTA, the peroneal artery perforator flaps of 3.5 cm×3.5 cm-9.5 cm×8.5 cm carried with lateral sural cutaneous nerve was designed and cut, and the nerve was anastomosed with the nerve of the wound. The wound in the donor site of the flap was directly sutured or covered with medium-thickness skin graft from the thigh. The consistencies of type, diameter, and perforating position of perforating vessel of the peroneal artery detected by 3D-CTA before the operation with those of the actual measurement during operation were observed. The length of time for flap cutting and the survival of the flap after operation were recorded. During follow-up of 12 months after the operation, the patients were instructed to evaluate the foot function according to the Maryland foot function score standard, and the wound healing in the donor area and the occurrence of complications affecting the motor function of limb were observed. Data were statistically analyzed with paired sample t test. Results The types of peroneal artery perforating vessels in patients measured during the operation were septocutaneous perforator of 12 cases, musculocutaneous perforator of 2 cases, and musculomuscular septal perforator of 1 case, which were consistent with those measured by preoperative 3D-CTA. The diameter of the peroneal artery perforating vessel measured by preoperative 3D-CTA was (1.38±0.17) mm, which was close to (1.40±0.19) mm measured during the operation (t=0.30, P>0.05). The horizontal distance from the starting point of the perforating vessel to the outer edge of the shank was (42±6) mm, and the vertical distance from the starting point of the perforating vessel to the level of the lateral ankle tip was (219±14) mm measured by preoperative 3D-CTA, which were respectively close to (43±6) and (221±15) mm of intraoperative measurement (with t values of 0.46 and 0.38, respectively, P>0.05). The length of time for cutting flap was (31±6) min. All flaps survived post operation without vascular crisis. During follow-up of 12 months after the operation, the foot function was evaluated as excellent in 11 cases, good in 3 cases, and fair in 1 case, the donor site wound healed well, the scar was not noticeable with no contracture, and the motor function of joints was not affected. Conclusions Free peroneal artery perforator flap is one of the effective methods to reconstruct skin and soft tissue defect wounds in the forefoot, and the risk of surgery can be reduced when the anatomical location of the perforating vessels is confirmed by 3D-CTA.
- Wound healing /
- Perforator flap /
- Angiography /
- Forefoot, human
王成德：研究设计、手术操作、实施研究、撰写论文；王爱、孙继玲：病例随访、资料整理；马文国、王建国：数据整理、论文修改

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1 腓动脉主干及穿支血管类型。1A.肌间隔穿支；1B.肌皮穿支；1C.肌肉-肌间隔穿支

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2 于三维CT血管造影（3D-CTA）辅助下行腓动脉穿支皮瓣游离移植修复交通伤患者右前足内侧皮肤软组织缺损创面。2A.术前右前足创面；2B.术前双小腿3D-CTA容积再现图像，显示腓动脉穿支血管类型为肌肉-肌间隔穿支；2C.术前设计皮瓣；2D.术中切取皮瓣；2E.皮瓣覆盖创面并缝合后即刻；2F.术后12个月随访，皮瓣外观较好，无臃肿

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