多穿支腓浅动脉穿支皮瓣修复手足创面的疗效

张韬; 程俊楠; 杨林; 黄永涛; 高钦锋; 孙丰文; 柳志锦; 刘胜哲; 杨成鹏; 曹阳; 巨积辉

doi:10.3760/cma.j.cn501225-20220723-00305

多穿支腓浅动脉穿支皮瓣修复手足创面的疗效

doi: 10.3760/cma.j.cn501225-20220723-00305

苏州瑞华骨科医院手外科，苏州　　215104

基金项目:

苏州市民生科技项目关键技术应用研究 SS202092

苏州市医疗卫生科技创新-应用基础研究项目 SKJY2021021

苏州市重点学科项目 SZXK202127

吴中区科技计划项目 WZYW2021001

详细信息

通讯作者:
巨积辉，Email：jjh2006@263.net

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出版历程
- 收稿日期: 2022-07-23

Curative effects of the superficial peroneal artery perforator flap carrying multiple perforators in repairing hand and foot wounds

Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Key Technology Application Research of Suzhou Livelihood Science and Technology Project SS202092

Suzhou Medical and Health Science and Technology Innovation-Applied Basic Research Program SKJY2021021

Suzhou Key Disciplines Program SZXK202127

Science and Technology Plan Project of Wuzhong District WZYW2021001

More Information

Corresponding author: Ju Jihui, Email: jjh2006@263.net

摘要

摘要: 目的探讨携带2条及以上同源穿支的腓浅动脉穿支皮瓣修复手足创面的疗效。方法采用回顾性观察性研究方法。2021年1—9月，苏州瑞华骨科医院收治23例符合入选标准的合并骨骼或肌腱外露的手足创面患者，其中男16例、女7例，年龄23~68岁。扩创后创面的面积为3.0 cm×2.0 cm~11.0 cm×4.0 cm，均采用携带2条及以上同源穿支的腓浅动脉穿支皮瓣修复创面，皮瓣切取面积为4.0 cm×2.0 cm~12.0 cm×5.0 cm。将所有供区创面直接缝合。术中记录皮瓣切取情况及携带穿支的数量与口径、腓浅动脉口径、血管蒂长度及腓浅动脉伴行静脉数量；术后观察皮瓣成活情况、并发症发生情况及供区创面愈合情况；随访观察供受区恢复情况，并于末次随访时采用综合评价量表评估皮瓣修复疗效，采用感觉分级量表评定受区感觉功能。结果术中共成功切取24块皮瓣，共携带56条腓浅动脉穿支，穿支口径为0.20~0.70 mm，7块皮瓣携带的所有穿支口径均<0.40 mm。19块皮瓣分别携带2条穿支，3块皮瓣分别携带3条穿支，1块皮瓣携带4条穿支，1块皮瓣携带5条穿支。术中切取腓浅动脉口径为0.40~1.50 mm，血管蒂长2~6 cm，腓浅动脉均有2条伴行静脉。术后皮瓣均顺利成活，未发生血管危象或远端坏死，供区创面均愈合良好。术后随访6~10个月，受区色泽、质地、弹性良好，其中6处受区因较臃肿行削薄整形；供区仅遗留线状瘢痕，无明显瘢痕增生或色素沉着，感觉及运动功能无明显变化。末次随访时，皮瓣修复疗效评定：优者22块、良者2块，受区感觉功能评定：S ₃级者1处、S ₂级者23处。结论携带2条及以上同源穿支的腓浅动脉穿支皮瓣血供充足可靠，修复手足创面的效果好，为术野内仅存在多条口径<0.40 mm的纤细穿支、仅保留单一穿支无法满足皮瓣血供及受区需要而放弃原手术方案的临床难题，提供了较为理想的解决方法。
- 手损伤 /
- 足损伤 /
- 穿支皮瓣 /
- 显微外科手术 /
- 创面修复 /
- 腓浅动脉穿支
Abstract: Objective To investigate the curative effects of the superficial peroneal artery perforator flap carrying two and more homologous perforators in repairing hand and foot wounds. Methods A retrospective observational study was conducted. From January to September 2021, 23 patients with hand and foot wounds combined with bone or tendon exposure who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 16 males and 7 females, aged 23 to 68 years. After expansion of the wound, the wound area was 3.0 cm×2.0 cm to 11.0 cm×4.0 cm. All the wounds were repaired with the superficial peroneal artery perforator flap carrying two and more homologous perforators. The area of the resected flap was 4.0 cm×2.0 cm to 12.0 cm×5.0 cm. All the wounds in donor areas were sutured directly. During the operation, the resection of the flap, the number and caliber of carried perforators, the caliber of superficial peroneal artery, the length of vascular pedicle, and the number of accompanying veins of the superficial peroneal artery were recorded. The survival of the flap, the occurrence of complications, and the wound healing in the donor area were observed after operation. The recovery of the donor and recipient areas was followed up. At the last follow-up, the comprehensive evaluation scale was used to evaluate the curative effect of flap repair, and the sensory grading scale was used to evaluate the sensory function of the recipient area. Results Totally 24 flaps were successfully resected in surgical operations, carrying 56 superficial peroneal artery perforators in total, with the caliber of perforators of 0.20-0.70 mm. The calibers of all perforators carried by 7 flaps were smaller than 0.40 mm. Nineteen flaps carried 2 perforators each, 3 flaps carried 3 perforators each, 1 flap carried 4 perforators, and 1 flap carried 5 perforators. During the operation, the superficial peroneal artery was resected with a caliber of 0.40-1.50 mm, the vascular pedicle was 2-6 cm in length, and each superficial peroneal artery had two accompanying veins. After operation, all the flaps survived smoothly, no vascular crisis or distal necrosis occurred, and the wounds healed well in the donor area. During the follow-up of 6 to 10 months after operation, the color, texture, and elasticity of the recipient area were good. Among them, 6 recipient areas were thinned and reshaped because of bloating. There was only linear scar and no obvious scar hyperplasia or pigmentation in the donor area, without significant change in sensory or motor function. At the last follow-up, the curative effect evaluation of flap repair was excellent in 22 flaps and good in 2 flaps, and the sensory function evaluation of the recipient area was grade S ₃ in 1 area and grade S ₂ in 23 areas. Conclusions The superficial peroneal artery perforator flap with two and more homologous perforators has sufficient and reliable blood supply and is effective in repairing hand and foot wounds. It provides an ideal solution for the clinical problem in which the original operation scheme is abandoned due to the existence of only multiple slender perforators of caliber smaller than 0.40 mm, and only a single perforator in the operative field that cannot satisfy the needs of the flap blood supply and recipient area.
- Hand injuries /
- Foot injuries /
- Perforator flap /
- Microsurgery /
- Wound repair /
- Superficial peroneal artery perforator
张韬：酝酿和设计研究、实施手术、采集资料、分析数据以及撰写论文；程俊楠、杨林：实施手术、采集资料以及分析数据；黄永涛、高钦锋、孙丰文、杨成鹏、曹阳：实施手术与采集资料；柳志锦、刘胜哲：实施手术、分析数据与修改文章；巨积辉：酝酿和设计研究、实施手术、分析数据、修改文章与获取研究经费

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1 携带2条同源穿支的腓浅动脉穿支皮瓣修复例1交通伤患者左足创面的效果。1A.皮瓣修复术前，左足背远端皮肤及左足第2趾趾体坏死；1B.选取近端2条穿支，于右小腿中1/3段设计皮瓣；1C.术中于深筋膜浅层可见2条定位穿支（红色箭头）进入皮瓣，均予以保留；1D.沿穿支逆行解剖观察到其均为腓浅动脉（红色箭头）来源；1E.皮瓣修复术后即刻外观；1F.将供区创面直接拉拢缝合后；1G.术后7个月，受区色泽良好，厚度较薄；1H.术后7个月，右小腿供区仅遗留线状瘢痕，未见明显瘢痕增生或色素沉着

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2 携带4条同源穿支的腓浅动脉穿支皮瓣修复例2机器压伤患者右手虎口区创面。2A.急诊术前，右手虎口区皮肤软组织缺损；2B.选取远端4条穿支，于左小腿中1/3段设计皮瓣；2C.术中于深筋膜浅层可见4条均为腓浅动脉（黄色箭头）来源定位穿支进入皮瓣，均予以保留；2D.皮瓣修复术后即刻外观；2E.将供区创面直接拉拢缝合后；2F.术后6个月，皮瓣存活良好，色泽良好，厚度较薄；2G、2H、2I.分别为术后6个月时右拇指对示指、中指、环指功能，均正常；2J.术后6个月，左小腿供区仅遗留线状瘢痕，未见明显瘢痕增生或色素沉着

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