足底外侧动脉第5跖骨穿支皮瓣修复前足外侧创面的效果

牛雪涛; 赵举辉; 何晓; 牟欢; 于泓; 马显杰; 赵定学; 张小锋

doi:10.3760/cma.j.cn501225-20240607-00217

足底外侧动脉第5跖骨穿支皮瓣修复前足外侧创面的效果

doi: 10.3760/cma.j.cn501225-20240607-00217

1.
汉中市中心医院整形外科,汉中　　723000
2.
汉中市中心医院骨关节外科,汉中　　723000
3.
空军军医大学第一附属医院整形外科,西安　　710032

基金项目:

陕西省卫生健康科研创新能力提升计划立项项目 2024PT-16

详细信息

通讯作者:
张小锋,Email：18991619937@163.com

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出版历程
- 收稿日期: 2024-06-07

Efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot

1.
Department of Plastic Surgery, Hanzhong Central Hospital, Hanzhong 723000, China
2.
Department of Orthopedics and Arthrology, Hanzhong Central Hospital, Hanzhong 723000, China
3.
Department of Plastic Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Shaanxi Province Health and Wellness Research Innovation Capability Enhancement Planning Project 2024PT-16

More Information

Corresponding author: Zhang Xiaofeng, Email: 18991619937@163.com

摘要

摘要: 目的探讨采用足底外侧动脉第5跖骨穿支皮瓣修复位于前足外侧的创面的效果。方法该研究为回顾性观察性研究。2020年7月—2023年7月,汉中市中心医院整形外科收治8例符合入选标准的前足外侧皮肤软组织缺损的患者,其中男6例、女2例,年龄22~72岁。患者中电烧伤者3例、外伤者4例、跖疣者1例。术前使用多普勒血流探测仪明确第5跖骨穿支血管数量及位置。术中测得创面大小为4.0 cm×3.0 cm~7.0 cm×5.0 cm,设计并切取面积为4.0 cm×4.0 cm~9.0 cm×6.0 cm的足底外侧动脉第5跖骨穿支皮瓣修复创面。采用同侧小腿中厚皮片修复供瓣区创面。记录手术时长、术中失血量。术后观察移植皮瓣、皮片成活情况。末次随访时,观察皮瓣外观、并发症发生情况,测量皮瓣两点辨别觉距离,观察供瓣区外形及患足感觉等功能。结果手术时长为70~100 min,平均84.6 min。术中失血量为30~80 mL,平均53.5 mL。术后皮瓣全部成活；仅1例患者供瓣区创面移植皮片部分坏死,经过换药并重新移植同侧小腿中厚皮片后创面愈合。术后随访6~24个月,平均13.8个月。末次随访时,所有患者皮瓣无臃肿畸形,无压力性溃疡发生,皮瓣两点辨别觉距离为5~13 mm,供瓣区无肌腱粘连、瘢痕增生,患足感觉及负重、行走功能均正常。结论采用足底外侧动脉第5跖骨穿支皮瓣修复前足外侧创面,具有皮瓣设计灵活、供瓣区损伤小且手术操作简单易行,术后足部外观及功能良好的优势,值得临床应用、推广。
- 创伤和损伤 /
- 足前段,人 /
- 穿支皮瓣 /
- 创面修复
Abstract: Objective To explore the efficacy of the fifth metatarsal perforator flap of the lateral plantar artery in repairing the wounds on the anterolateral side of the foot. Methods This study was a retrospective observational study. Eight patients with skin and soft tissue defects on the anterolateral side of the foot and conformed to the inclusion criteria were admitted to the Department of Plastic Surgery of Hanzhong Central Hospital from July 2020 to July 2023. There were 6 males and 2 females, aged 22 to 72 years. Among the patients, there were three patients with electrical burns, four patients with trauma, and one patient with plantar wart. Preoperatively, a Doppler blood flow detector was used to clarify the number and location of the fifth metatarsal perforating vessels. The area of the wounds measured during the operation ranged from 4.0 cm×3.0 cm to 7.0 cm×5.0 cm, and the fifth metatarsal perforator flaps of the lateral plantar artery with area of 4.0 cm×4.0 cm to 9.0 cm×6.0 cm were designed and harvested to repair the wounds. The wounds in the flap donor sites were repaired with medium-thickness skin grafts from lower limb on the same side. The duration of surgery and intraoperative blood loss volume were recorded. The survivals of the transplanted flap and skin graft were observed after surgery. At the last follow-up, the appearance of the flap and the occurrence of complication were observed, the two-point discrimination distance of the flap was measured, and the shape of the flap donor site as well as the sensation and other functions of the affected foot were observed. Results The duration of surgery ranged from 70 to 100 min, with an average of 84.6 min. The intraoperative blood loss volume ranged from 30 to 80 mL, with an average of 53.5 mL. After surgery, all flaps survived completely; only one patient developed partial necrosis of the skin graft in the wound in flap donor site, and the wound healed completely after dressing change and re-grafting medium-thickness skin graft from lower limb on the same side. Postoperative follow-up was conducted for 6 to 24 months, with an average of 13.8 months. At the last follow-up, none of the patients developed bloated and deformed flaps or pressure ulcers, and the two-point discrimination distance of the flap ranged from 5 to 13 mm. No tendon adhesion or scar hyperplasia was observed in the flap donor sites, and the sensation, weight-bearing, and walking functions of the affected feet were normal. Conclusions The use of the fifth metatarsal perforator flap of the lateral plantar artery for repairing the wounds on the anterolateral side of the foot has the advantages of flexible flap design, minimal damage to the flap donor site, simple and feasible surgical operation, and good postoperative foot appearance and function, which is worthy of clinical application and promotion.
- Wounds and injuries /
- Forefoot, human /
- Perforator flap /
- Wound repair
牛雪涛、张小锋：酝酿和设计研究、实施手术、撰写文章；赵举辉、牟欢：参与手术、采集资料；何晓：采集资料、分析数据、修改文章；于泓、赵定学：采集资料、分析数据、获取研究经费；马显杰：对文章的知识性内容作批评性审阅,指导修改文章

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参考文献(40)

[1]	RasmussenCG, JørgensenSB, LarsenP, et al. Population-based incidence and epidemiology of 5912 foot fractures[J]. Foot Ankle Surg, 2021,27(2):181-185. DOI: 10.1016/j.fas.2020.03.009.
[2]	吴昌盛,潘振宇,李平华,等.缝合神经的游离股前外侧皮瓣修复前足皮肤缺损皮瓣感觉恢复情况的中期随访[J].中华显微外科杂志,2018,41(4):371-373.DOI: 10.3760/cma.j.issn.1001-2036.2018.04.014.
[3]	HansenR, ShibuyaN, JupiterDC. An updated epidemiology of foot and ankle fractures in the United States: complications, mechanisms, and risk factors[J]. J Foot Ankle Surg, 2022, 61(5):1034-1038. DOI: 10.1053/j.jfas.2022.01.010.
[4]	赵仙丽,李心瑜,吴绪波,等.足部评估及训练预防跑步损伤的研究进展[J].康复学报,2022,32(5):471-476.DOI: 10.3724/SP.J.1329.2022.05013.
[5]	孙向东,阿布都赛米江·阿西木,乔维龙,等.游离股前外侧穿支皮瓣修复糖尿病足溃疡的应用[J].中国临床解剖学杂志,2024,42(5):570-574.DOI: 10.13418/j.issn.1001-165x.2024.5.14.
[6]	KaramanidisK,ArampatzisA,BrüggemannGP.Reproducibility of electromyography and ground reaction force during various running techniques[J].Gait Posture,2004,19(2):115-123.DOI: 10.1016/S0966-6362(03)00040-7.
[7]	柯竟悦,马圣楠,董洪铭,等.不同足姿受试者运动贴扎后步行及慢跑时的足底压力变化[J].中国组织工程研究,2024,28(18):2800-2807.DOI: 10.12307/2024.051.
[8]	林琴琴,李若明,耿元文,等.3-35岁健康男性自然行走时足底压力的特征与变化[J].中国组织工程研究,2021,25(15):2315-2320.DOI: 10.3969/j.issn.2095-4344.3804.
[9]	鹿亮,孙怡宁,马祖长.糖尿病足底压力研究进展[J].中华骨与关节外科杂志,2024,17(6):566-572.DOI: 10.3969/j.issn.2095-9958.2024.06.11.
[10]	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.
[11]	孙浩然,黄东旭,窦义臣,等.足跖背动脉穿支逆行皮瓣修复前足软组织缺损43例[J].中华显微外科杂志,2017,40(3):234-236.DOI: 10.3760/cma.j.issn.1001-2036.2017.03.007.
[12]	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.
[13]	WuJ,WuJ,GongX,et al.Repairing pretibial and foot soft tissue defects with reverse transplantation of the medial crural fasciocutaneous flap[J].Int J Low Extrem Wounds,2016,15(1):34-40.DOI: 10.1177/1534734615597864.
[14]	BattistonB, CiclaminiD, TangJB. Compound or specially designed flaps in the lower extremities[J]. Clin Plast Surg, 2020, 47(4):535-546. DOI: 10.1016/j.cps.2020.06.006.
[15]	AcarMA,GüleçA,AydinBK,et al.Reconstruction of foot and ankle defects with a free anterolateral thigh flap in pediatric patients[J].J Reconstr Microsurg,2015,31(3):225-232.DOI: 10.1055/s-0034-1395888.
[16]	周建东,张兴飞,许同龙,等.浅筋膜浅深交界层平面逆行分离穿支血管切取超薄股前外侧皮瓣修复足部创面[J].中华显微外科杂志,2022,45(5):515-520.DOI: 10.3760/cma.j.cn441206-20220516-00098.
[17]	葛成伟,蒋国栋,程俊楠,等.以旋股外侧动脉斜支为蒂并携带阔筋膜的股前外侧穿支皮瓣修复手足毁损性创面并重建功能的效果[J].中华烧伤与创面修复杂志,2024,40(9):842-848.DOI: 10.3760/cma.j.cn501225-20240508-00163.
[18]	单国华,胡继燕,赵峰刚,等.3种足部带蒂皮瓣修复前足软组织深度缺损的疗效[J].临床骨科杂志,2023,26(6):813-815.DOI: 10.3969/j.issn.1008-0287.2023.06.018.
[19]	YangR, ZhouM, XingC, et al. Repair of bone defect of the lateral forefoot by double segment triangular fibula flap with vascular pedicle: a case report[J]. Saudi J Biol Sci, 2017,24(8):1907-1912. DOI: 10.1016/j.sjbs.2017.11.038.
[20]	石玲玲,吴进,郭志民,等.游离股前外侧皮瓣修复足底负重区软组织缺损的效果[J].组织工程与重建外科杂志,2023,19(6):541-543,548.DOI: 10.3969/j.issn.1673-0364.2023.06.004.
[21]	牟勇,黎路根,毛莉颖,等.超薄股前外侧穿支皮瓣修复足底黑色素瘤术后创面[J].广东医学,2019,40(24):3378-3382.DOI: 10.13820/j.cnki.gdyx.20190566.
[22]	杨涛,熊颖杰,胡智玉,等.游离足底内侧皮瓣串联股前外侧皮瓣修复足底负重区大面积软组织缺损[J].中华显微外科杂志,2021,44(4):398-402.DOI: 10.3760/cma.j.cn441206-20200808-00313.
[23]	吴健,罗想利,薛晓东,等.足底内侧动脉皮瓣修复足跟、前足底电烧伤创面21例[J].中国临床研究,2017,30(1):61-63.DOI: 10.13429/j.cnki.cjcr.2017.01.017.
[24]	JastiferJR. Intrinsic muscles of the foot: anatomy, function, rehabilitation[J]. Phys Ther Sport, 2023, 61:27-36. DOI: 10.1016/j.ptsp.2023.02.005.
[25]	欧阳容兰,黄书润.基于美学理念的足底内侧岛状皮瓣修复足跟部软组织缺损[J].中国美容医学,2021,30(3):48-50.
[26]	景胜杰,田峰.足跟分区与各区皮肤缺损修复研究进展[J].中国美容整形外科杂志,2020,31(7):425-426,后插4.DOI: 10.3969/j.issn.1673-7040.2020.07.013.
[27]	HuangL, PafitanisG, SongD, et al. Anatomical basis of the intermediate dorsal pedal neurocutaneous perforator pedicled propeller flap: a cadaveric dissection[J]. Clin Anat, 2018, 31(7):1077-1084. DOI: 10.1002/ca.23229.
[28]	尹永涛,沈凯,宋力,等.以踝周知名分支血管为蒂低位逆行岛状外踝上穿支皮瓣修复前中足软组织缺损[J].临床外科杂志,2020,28(11):1078-1081.DOI: 10.3969/j.issn.1005-6483.2020.11.025.
[29]	ImanishiN,KishK,ChangH,et al.Anatomical study of cutaneous venous flow of the sole[J].Plast Reconstr Surg,2007,120(7):1906-1910.DOI: 10.1097/01.prs.0000287277.63805.d2.
[30]	HaqA,SinghV,SharmaS.Medial plantar artery-based perforator and island flaps: a case series of applications in sole defects[J].J Wound Care,2022,31(2):130-138.DOI: 10.12968/jowc.2022.31.2.130.
[31]	陈实,邱志龙,颜翼,等.游离超薄股前外侧穿支皮瓣修复足踝皮肤软组织缺损[J].中国矫形外科杂志,2016,24(14):1340-1343.DOI: 10.3977/j.issn.1005-8478.2016.14.21.
[32]	赵勇刚,杨铭华,郭德华,等.四种游离皮瓣修复前足及足底软组织缺损[J].中华显微外科杂志,2014,37(2):193-194.DOI: 10.3760/cma.j.issn.1001-2036.2014.02.033.
[33]	曹子君,王芳,李雪梅,等.糖尿病患者步态周期不同时刻的足底压力及中底结构设计[J].中国组织工程研究,2023,27(13):2005-2010.
[34]	孙琪博,陈默迪,邰国梁,等.带神经股前外穿支削薄皮瓣修复足踝大面积创面[J].中国矫形外科杂志,2022,30(14):1307-1310.DOI: 10.3977/j.issn.1005-8478.2022.14.12.
[35]	PappC,TodoroffBP,WindhoferC,et al.Partial and complete reconstruction of Achilles tendon defects with the fasciocutaneous infragluteal free flap[J].Plast Reconstr Surg,2003,112(3):777-783.DOI: 10.1097/01.PRS.0000073975.01321.8B.
[36]	KuoYR,KuoMH,ChouWC,et al.One-stage reconstruction of soft tissue and Achilles tendon defects using a composite free anterolateral thigh flap with vascularized fascia lata: clinical experience and functional assessment[J].Ann Plast Surg,2003,50(2):149-155.DOI: 10.1097/01.SAP.0000037270.95257.B9.
[37]	丁汉文,陈勇,王倩,等.带蒂轴型皮瓣修复踝周皮肤软组织缺损:病例报道与策略分析[J].组织工程与重建外科杂志,2023,19(3):253-257.DOI: 10.3969/j.issn.1673-0364.2023.03.007.
[38]	石建国,王继宏,杨彦君.不同类型皮瓣修复足踝部软组织缺损的效果对比[J].组织工程与重建外科杂志,2022,18(4):315-318.DOI: 10.3969/j.issn.1673-0364.2022.04.006.
[39]	WangT,LinJ,SongD,et al.Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection[J].Surg Radiol Anat,2017,39(2):141-147.DOI: 10.1007/s00276-016-1712-z.
[40]	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.

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图 1 采用足底外侧动脉第5跖骨穿支皮瓣修复例1患者前足外侧创面的效果。1A.清创术后右足第5跖趾关节、肌腱外露,根据创面大小和形状设计皮瓣；1B.术中分离皮瓣并显露穿支；1C.术中转移皮瓣覆盖创面后即刻；1D.转移皮瓣后的创面采用中厚皮片修复后即刻；1E、1F.分别为术后1年足部侧面观、足底观,皮瓣外形无臃肿,色泽与周围正常皮肤接近,足外观良好

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图 2 采用足底外侧动脉第5跖骨穿支皮瓣修复例2患者前足外侧创面的效果。2A.入院时左足跖骨外侧皮肤软组织缺损；2B.皮瓣修复术中见第5跖趾关节部分损毁、跖骨外露,根据创面大小和形状设计皮瓣；2C.术中分离皮瓣并显露穿支；2D.转移皮瓣覆盖跖骨外露创面,供瓣区创面移植中厚皮片修复后即刻；2E、2F.分别为术后6个月足部侧面观、足背观,皮瓣外形无臃肿,色泽与周围正常皮肤接近,足外观良好

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