内增压型腓肠内侧动脉穿支皮瓣修复手足部皮肤软组织缺损的效果

张岩; 金光哲; 曹阳; 吴成龙; 王桂洋; 王石; 董帅; 张玉基; 刘禹城; 巨积辉

doi:10.3760/cma.j.cn501225-20241029-00419

内增压型腓肠内侧动脉穿支皮瓣修复手足部皮肤软组织缺损的效果

doi: 10.3760/cma.j.cn501225-20241029-00419

1.
苏州瑞华骨科医院手外科,苏州　215104
2.
苏州大学苏州医学院,苏州215123
3.
苏州瑞华骨科医院创面修复科,苏州　215104

基金项目:

苏州市医学重点学科 SZXK202127

详细信息

通讯作者:
金光哲,Email：jgz2020@suda.edu.cn

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出版历程
- 收稿日期: 2024-10-29
- 网络出版日期: 2026-03-03

Efficacy of turbocharged medial sural artery perforator flap in repairing skin and soft tissue defects of hands and feet

1.
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China
2.
Suzhou Medical College of Soochow University, Suzhou 215123, China
3.
Department of Wound Repair, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China

Funds:

Suzhou Key Medical Discipline SZXK202127

More Information

Corresponding author: Jin Guangzhe, Email: jgz2020@suda.edu.cn

摘要

摘要: 目的探讨应用内增压型腓肠内侧动脉穿支皮瓣修复手足部皮肤软组织缺损的效果。方法该研究为回顾性病例系列研究。2022年9月—2023年11月,苏州瑞华骨科医院收治12例符合入选标准的手足部皮肤软组织缺损患者,其中男8例、女4例,年龄32~69岁。清创后创面缺损面积为5.5 cm×3.5 cm~13.5 cm×5.5 cm,应用面积为6.0 cm×4.0 cm~14.0 cm×6.0 cm内增压型腓肠内侧动脉穿支皮瓣修复缺损,将供区创面直接拉拢缝合。记录皮瓣切取情况及术后存活情况、血管危象发生情况及供区创面术后愈合情况。随访观察皮瓣外观与质地、供区创面瘢痕及疼痛情况。末次随访时,采用综合评价量表评价皮瓣移植效果,采用英国医学研究会感觉功能评定标准评定皮瓣感觉功能。结果皮瓣均顺利切取且术后存活良好,未发生血管危象；供区创面术后均顺利愈合。随访6~15个月显示,皮瓣外观良好且质地优良,供区创面仅遗留线性瘢痕且无瘢痕挛缩及疼痛等不适。末次随访时,皮瓣移植效果评价为优者9例、良者3例,皮瓣感觉功能评定为S1级者1例、S2级者8例、S3级者3例。结论应用内增压型腓肠内侧动脉穿支皮瓣修复手足部皮肤软组织缺损,术后供受区外形与功能恢复良好,是该类缺损有效的修复方法之一。
- 创伤和损伤 /
- 手 /
- 足 /
- 外科皮瓣 /
- 显微外科手术 /
- 腓肠内侧动脉穿支皮瓣 /
- 内增压 /
- 创面修复
Abstract: Objective To explore the efficacy of turbocharged medial sural artery perforator flap in repairing skin and soft tissue defects of hands and feet. Methods This study was a retrospective case series study. From September 2022 to November 2023, 12 patients with skin and soft tissue defects of hands and feet who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 8 males and 4 females, aged 32-69 years. After debridement, the wound defect area ranged from 5.5 cm×3.5 cm to 13.5 cm×5.5 cm. The defects were repaired with turbocharged medial sural artery perforator flaps with an area of 6.0 cm×4.0 cm to 14.0 cm×6.0 cm, and the donor site wounds were directly closed by suturing. The flap harvesting status, postoperative survival, occurence of vascular crisis, and healing of donor site wounds were recorded. During follow-up, the appearance and texture of the flaps, as well as the scarring and pain of the donor site wounds were observed. At the last follow-up, a comprehensive evaluation scale was used to assess the flap transplantation effect, and the British Medical Research Council sensory function grading standard was adopted to evaluate the sensory function of the flaps. Results All flaps were harvested successfully and survived well postoperatively without vascular crisis; all donor site wounds healed smoothly. Follow-up for 6-15 months showed that the flaps had a good appearance and excellent texture, and the donor site wounds only were left with linear scars without scar contracture, pain, or other discomfort. At the last follow-up, 9 cases were rated as excellent and 3 cases as good in terms of flap transplantation effect; the sensory function of the flaps was graded as grade S1 in 1 case, grade S2 in 8 cases, and grade S3 in 3 cases. Conclusions The application of turbocharged medial sural artery perforator flap for repairing skin and soft tissue defects of hands and feet achieves good postoperative appearance and function recovery of both donor and recipient sites, making it one of the effective repair methods of this kind of defect.
- Trauma and injuries /
- Hand /
- Foot /
- Surgical flaps /
- Microsurgery /
- Medial sural artery perforator flap /
- Turbocharging /
- Wound repair
张岩：负责酝酿和设计研究、实施手术、采集资料、分析数据与撰写论文；金光哲、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；曹阳、吴成龙、王桂洋、王石、董帅、张玉基、刘禹城：负责手术实施与采集资料

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参考文献(40)

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图 1 采用右侧内增压型腓肠内侧动脉穿支皮瓣修复例1患者右足背部皮肤软组织坏死创面的效果。1A.术前见右足第2~4趾及足背部分皮肤坏死；1B.术中皮瓣的设计；1C.术中切取的携带2条穿支的皮瓣；1D.对皮瓣行内增压处理中；1E.清创后右足背创面和内增压处理后的皮瓣；1F.皮瓣修复创面后即刻外观；1G.右小腿供区直接缝合后即刻外观；1H.术后6个月时,右足皮瓣外观；1I.术后6个月时,供区恢复情况

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图 2 采用左侧内增压型腓肠内侧动脉穿支皮瓣修复例2患者右手背部皮肤软组织坏死创面的效果。2A.术前右手背皮肤缺损情况；2B.术中皮瓣的设计；2C.术中切取的携带2条穿支的皮瓣；2D.对皮瓣行内增压处理中；2E.行内增压处理后的皮瓣；2F.皮瓣修复创面后即刻外观；2G.左小腿供区直接缝合即刻外观；2H.术后8个月时,右手背皮瓣外观；2I.术后8个月时,供区恢复情况

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