应用多普勒定位随意型穿支蒂螺旋桨皮瓣修复小腿及足踝部软组织缺损的疗效分析

Application of freestyle perforator pedicled propeller flaps using Doppler localization preoperatively for soft-tissue coverage of the shank or ankle defects

关键词:  穿支皮瓣  多普勒  螺旋浆  下肢  显微外科手术

Key words:  perforator flap  B-ultrasound  propeller  lower limb  microsurical operation

摘要:

目的　研究术前多普勒定位随意型穿支蒂螺旋桨皮瓣修复小腿及足踝部软组织缺损的临床疗效。方法　收集2013年7月至2015年7月19例小腿及足踝部软组织缺损患者，缺损面积约3 cm×6 cm～6 cm×18 cm。术前进行创面处理及多普勒定位皮瓣穿支血管，以多普勒探测的穿支血管为旋转点，结合创面大小，设计穿支血管蒂螺旋桨皮瓣修复创面，观察术中及术后情况。结果　穿支动脉分别来源于胫后动脉10例，腓动脉6例，腓肠内侧动脉3例。皮瓣面积3 cm×8 cm～8 cm×23 cm。本组11例皮瓣完全成活，术后无血管危象，无皮瓣淤紫及水泡；8例皮瓣远端部分坏死，经换药等对症治疗后愈合，其中2例经二期植皮覆盖创面。8例供区切口直接缝合，11例供区经植皮后完全愈合，切口均一期愈合。术后随访6～24个月，平均9.5个月，术后随访皮瓣颜色红润，质地优良，外观臃肿不明显，弹性良好。结论　术前应用多普勒定位随意型穿支蒂螺旋桨皮瓣设计科学、血流符合生理、血供丰富且不牺牲主要动脉，临床实用性较强。

Abstract:

Objective To explore the effect of using freestyle perforator pedicled propeller flaps by Doppler localization preoperatively to repair soft-tissue defects in the shank or ankle. Methods From July 2012 to July 2015, 19 cases with soft tissue defect of the shank or ankle had been repaired by freestyle perforator pedicled propeller flaps using B-ultrasound localization preoperatively. The origins of the perforator were from posterior tibial artery in 10 cases， from peroneal artery in 6 cases, and from medial sural artery in 3 cases. Those flaps ranged from 3 cm×8 cm to 8 cm×23 cm．Results All of the 11 flaps survived without vascular crisis, purple bruise and bleb. Distal and proximal partial necrosis occurred in 8 cases, which eventually resulted in scar healing. Among them, 2 cases needed skin graft to cover the wound. The donor sites were closed directly in 8 cases and covered with free skin graft from abdomen in 19 cases. The patients were followed up from 6 to 24 months (mean 9.5 months)．The appearance and function of these flaps were satisfactory．Conclusion The application of freestyle perforator pedicled propeller flaps using B-ultrasound localization preoperatively can be ideal for skin and soft defects of the shank or ankle as a simple，safe，and versatile procedure．