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两种蒂的小腿后筋膜皮瓣的临床应用

摘要:目的: 探讨修复膝、小腿前、足踝部骨外露创面的简单有效的方法。 方法 :2002年1月至2007年12月,应用两种皮瓣,以腓肠神经营养血管为蒂的小腿后逆行筋膜皮瓣和以腘动脉发出的皮动脉为蒂的小腿后侧顺行皮瓣,前者用以修复足踝、小腿中下部创面19例,后者用来修复膝及小腿中上部创面10例。 结果 : 28例皮瓣全部成活,1例逆行皮瓣远端部分坏死,部分胫骨外露行腓肠肌肌皮瓣修复。所有病例均经3个月以上随诊,皮瓣成活良好,外形较满意。合并开放骨折者10例,8例半年以上随访,7例骨痂生长良好,1例无骨痂生长。 结论 :小腿后区是修复膝、胫前、踝、足部软组织缺损的良好供区,两种设计间有很好的互补性,应用得当可满足绝大多数该部位创面的修复。

逆行前踝上岛状皮瓣修复足背部软组织缺损

胫前肌和胫后肌半腱联合转移治疗顽固型马蹄内翻足

总结胫前肌和胫后肌半腱联合转移治疗软组织挛缩顽固型马蹄内翻足的疗效。 方法 2003年1 月－ 2008 年1 月，采用胫前肌和胫后肌半腱联合转移手术治疗26 例软组织挛缩顽固型马蹄内翻足患儿。其中男17例，女9 例；年龄1 岁6 个月～ 5 岁，平均2.1 岁。双足12 例，单足14 例。其中2 例2 足为术后复发患儿。 结果 术后3 例4 足足后内侧切口因缝合张力原因愈合不佳，经换药后愈合；余切口Ⅰ期愈合。患儿均获随访，随访时间1 ～ 5 年，平均3 年10 个月。患足均能达跖行步态，外形和功能恢复良好。参照Garceau 等疗效评定标准，优16 足，良18 足，可4 足，优良率89.47%。随访期内无复发。 结论 胫前肌和胫后肌半腱联合转移是矫治顽固型马蹄内翻足的一种较好方法。

胫前动脉踝上穿支皮瓣修复足背软组织缺损

目的 为足背部皮肤及软组织缺损修复探讨一种新型供血来源的皮瓣。 方法 2003年11月~2005年12月，设计以胫前动脉踝上穿支为供血的皮瓣修复足背皮肤软组织缺损7例，其中男5例，女2例；年龄8～56岁。车祸伤2例，砸伤后慢性溃疡2例，电击伤、浓硫酸烧伤、热钢筋洞穿伤各1例。均合并软组织缺损、肌腱骨质外露，缺损范围：4.5 cm×3.0 cm～10.0 cm×9.0 cm。病程1 h～12个月。术中切取皮瓣6 cm×5 cm~10 cm×10 cm，穿支皮瓣蒂长1.5~2.7 cm；皮瓣血管蒂位于踝上6～12 cm。 结果 术后7例皮瓣全部成活，无淤血、坏死及张力性水泡发生。随访6~18个月，皮瓣外形及功能恢复满意，术后1年感觉恢复良好，两点辨别觉为6~12 mm。 结论 以胫前动脉踝上穿支为供血的皮瓣修复足背软组织缺损，手术操作简便，安全可靠，是一种较理想的皮瓣供区。

腓肠肌筋膜蒂皮瓣移位修复胫前皮肤缺损

胫前血管桥接游离股前外侧皮瓣修复小腿严重毁损伤

逆行胫前动脉岛状皮瓣修复足部皮肤软组织缺损

目的 探讨应用带蒂逆行胫前动脉皮支岛状皮瓣修复足部皮肤软组织缺损的疗效。 方法 2000年7月～2005年4月，收治10例各种原因致足部皮肤软组织缺损，均存在不同程度的骨、关节与肌腱外露，软组织缺损范围6 cm×4 cm ～16 cm×10 cm。急诊修复7例；择期手术3例，其中1例足部黑色素瘤7年伴皮肤破溃5个月，行手术扩大切除。应用带蒂的胫前动脉皮支岛状皮瓣逆行移位修复，皮瓣切取范围8 cm×5 cm ～17 cm×12 cm 。 结果 术后皮瓣均成活，创口Ⅰ期愈合。随访1～21个月，皮瓣外观好，不臃肿，无感染、破溃。足部外形满意，行走正常，皮肤两点辨别觉1.0～2.5 cm。 结论 胫前动脉皮支皮瓣血管解剖恒定，易于解剖，皮瓣可切取面积大，手术方法简便，成功率高 ，适用于足部皮肤软组织缺损的修复。

Anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap for foot and ankle defect

ObjectiveTo investigate the clinical application of the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap in repair of foot and ankle defects.MethodsBetween October 2014 and October 2018, 18 cases with foot and ankle defects were treated. There were 12 males and 6 females with an average age of 32.8 years (range, 8-56 years). There were 11 cases of traffic accident injuries, 3 cases of falling from height injuries, and 4 cases of heavy objects injuries. The wound was at the dorsum of the foot in 9 cases, the heel in 4 cases, the lateral malleolus in 5 cases. The time from injury to flap repair was 7-34 days (mean, 19 days). The size of wound ranged from 6.0 cm×2.5 cm to 11.0 cm×6.0 cm. The foot and ankle defects were repaired with the peroneal artery terminal perforator propeller flap in size of 6 cm×3 cm-18 cm×7 cm, which donor site was repaired with the anterior tibial artery perforator propeller flap in size of 8 cm×3 cm-16 cm×6 cm.ResultsOne patient had a hemorrhagic swelling in the peroneal artery terminal perforator propeller flap, and survived after symptomatic treatment. All recipient and donor sites healed by first intention. Eighteen patients were followed up 6-15 months (mean, 12.5 months). At last follow-up, the shape, color, texture, and thickness of the flaps in the donor sites were similar with those in the recipient sites. There were only linear scars on the donor sites. The two-point discrimination of the peroneal artery terminal perforator propeller flap ranged from 10 to 12 mm (mean, 11 mm). According to American Orthopaedic Foot and Ankle Society (AOFAS) score criteria, the results were excellent in 15 cases and good in 3 cases, with an excellent and good rate of 100%.ConclusionThe foot and ankle defects can be repaired with the anterior tibial artery perforator propeller flap relay peroneal artery terminal perforator propeller flap. The procedure is not sacrificing the main vessel and can avoid the skin grafting and obtain the good ankle function.

FREE MULTIPLE FLAPS OF LOWER EXTREMITY FOR SEVERLY BURNED HAND RECONSTRUCTION

Objective To introduce the free multiple flaps of lowerextremity based on the anterior tibital vascular pedicle for primary repair of the complex burned hand deformities.Methods From September 2000 to February 2003, the lateral leg flap, dosalis pedis flap and trimmed first toe based on the anterior tibial vascular pedicle were utilized to reconstruct the thumb and repair the first web, thenar, wrist or palmar scar contracture simultaneously in 6 patients. The flap size of lateral leg and dosalis pedis ranged from 4 cm×10 cm to 7 cm×10 cm and from 5 cm×10 cm to 9 cm×12 cm, respectively.Resutls Six cases were treated and followed up for 6 weeks to 1 year. The transplanted flaps survived with satisfactory recovery in function and appearance of theburned hand. The function of donor lower extremity was not damaged. Conclusion The procedure of the free multiple flaps of lower extremity based on the anterior tibial vascular pedicle is reliable and effective for primaryrepair of burned hand.

APPLIED ANATOMY OF OSTEO PERIOSTEAL FLAP PEDICLED WITH SUPERIOR MALLEOLAR BRANCH OF ANTERIOR TIBIAL ARTERY

In order to investigate the blood supply of osteo-periosteal flap of lateral inferior part of tibia, 40 lower limbs of adult cadavers were observed. The result showed that the superior malleolar branch was the biggest branch on the lateral inferior part of tibia and served as the main blood supply to the above area. It originated from the anterior tibial artery, 3.1 +/- 0.8 cm above the intermalleolar line. During its way to the anterior border of the tibia, it gave out the ascending and descending branches. The ascending branch was along the anterior border upward and anastomosed with the musculo-periosteol branch of the anterior tibial artery at the level of 6.3 +/- 1.3 cm above the intermalleolar line. The decending branch was anastomosed with the anterior medial malleolar artery. For the anastomosis between the superior malleolar branch with the peripheral vessels, the osteo-periosteol flap could be designed at the lateral side of the lower part of tibia in size of 8-10 cm x 4-6 cm. This was a new donor area of osteo-periosteol flap for repair of non-union of bone in lower end of tibia or arthrodesis of the ankle joint.