分叶及嵌合的腓肠内侧动脉穿支皮瓣在修复足部大面积复合组织缺损中的临床应用
Clinical application of lobulated and chimeric medial sural artery perforator flap in repairing large composite tissue defects in the foot
邱俊涛 1路闯 1袁野 1李辉 1李高辉 1刘冲 1姚刘永1
作者信息
- 1. 中国人民解放军联勤保障部队第990医院骨显微外科,河南驻马店 463000
- 折叠
摘要
目的 探讨分叶及嵌合的腓肠内侧动脉穿支皮瓣移植重建足部复合组织缺损的方法及临床疗效.方法 2014年5月-2022年10月收治足部大面积复合组织缺损患者8例,均有不同程度的骨及肌腱韧带缺损、骨坏死、骨感染情况,采用以腓肠内侧动脉穿支血管作为营养血管,术中通过多普勒彩超和DSA结合,精准定位并设计,通过增加皮瓣长度和减少宽度,可以使供区直接缝合,然后通过分叶、重组,将分叶皮瓣和肌皮瓣合理嵌合后进行移植修复,利用肌皮瓣可以有效填充残腔,重建韧带及关节囊.结果 术后8例皮瓣均成活,1例因血肿压迫皮瓣静脉回流出现静脉危象,清除血肿及拆除缝线后,静脉危象解除,皮瓣成活.所有患者供受区愈合良好,无积血、伤口感染等情况发生.随访6～36个月,平均25个月,皮瓣色泽与周围皮肤相差不大,仅皮瓣周围存留线性瘢痕,质地良好,弹性好,其中1例女性患者修复关节周围的皮瓣略显臃肿,小腿供区仅留下线状瘢痕,小腿后侧肌肉功能均正常.结论 腓肠内侧分叶嵌合皮瓣血管恒定,穿支相对恒定,血供可靠,手术操作相对简单,通过术前合理设计后将皮瓣宽度变为长度,把不规则创面调整为规则,以实现供区切口直接闭合,避免供区的二次创伤,通过嵌合肌皮瓣填充死腔,将肌皮瓣与关节囊或韧带固定缝合,有利于重建局部组织结构的稳定性,可以大大降低后期肢体畸形的发生,是修复足部大面积复合组织缺损的一种较为理想的选择方法.
Abstract
Objective To explore the method and clinical efficacy of using segmented and chimeric medial sural artery perforator flap transplantation to reconstruct composite tissue defects in the foot.Methods From May 2014 to October 2022,treated 8 patients with large-scale composite tissue defects in the feet,all had various degrees of bone and tendon ligament defects,bone necrosis,and bone infection,all used the perforating vessels of the medial sural artery as nutrient vessels.During the surgery,doppler ultrasound and DSA were combined to accurately locate and design,and the length of the skin flap was incr eased and reduced.The width allowed for direct suturing of the donor site,and then through lobulation and recombination,the lobulated skin flap and muscle flap were reasonably integrated for transplantation and repair.The use of muscle flap could effectively fill the residual cavity,reconstruction of ligaments and joint capsules.Results Seven flaps did not show any adverse reactions and remained in good condition.One flap had poor capillary filling test on the second day after surgery,with a large amount of exudation around the flap.It was considered a venous crisis,and it was believed that postoperative swelling tissue compressed the flap veins,resulting in poor reflux.After removing the suture to remove the hematoma and hemostasis on the wound,the resistance of the flap's venous reflux was reduced.After relieving the venous crisis,the capillary reaction of the flap was normal,with very little exudation around it,and no further adverse conditions occurred.The flap survived,the wound healed in the first stage,and there was no wound infection.Followed up for 6-36 months,with an average of 25 months,showed that the skin color of the flap was close to that of the normal surrounding skin.There were linear scars around the flap,with normal texture and good elasticity.Only one female patient had a slightly swollen skin flap.After undergoing microscopic thinning plastic surgery in the second stage,the swelling was eliminated,leaving only linear scars;The calf donor area only left linear scars,as the gastrocnemius muscle was very rich and had no impact on the joint function of the lower limbs in the later stage.Conclusion The medial gastrocnemius lobulated chimeric flap has constant blood vessels,relatively constant perforating branches,reliable blood supply,and relatively simple surgical operation.Through reasonable preoperative design,the width of the flap is changed to length,and irregular wounds are adjusted to be regular to achieve direct closure of the donor site incision and avoid secondary trauma.By filling the dead space with the chimeric muscle flap,the muscle flap is fixed and sutured with the joint capsule or ligament,which is beneficial for reconstructing the stability of local tissue structure and greatly reducing the occurrence of limb deformities in the later stage.
关键词
腓肠内侧动脉/穿支皮瓣/复合组织瓣/功能重建Key words
Medial sural artery/Perforator flap/Compound tissue flap/Functional reconstruction引用本文复制引用
出版年
2024
NETL
NSTL
万方数据