足底邻近穿支筋膜皮瓣的解剖特点及临床应用

中华显微外科杂志 Pub Date : 2018-08-25 DOI:10.3760/CMA.J.ISSN.1001-2036.2018.04.009

Jing Wang, Xiao-jing Li, Jin-long Ning, Xin-yi Li, M. Tang

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引用次数: 0

摘要

目的探讨植物邻近穿支筋膜皮瓣的解剖学基础及临床应用效果。方法2010年10月至2017年12月，开展两方面的工作:①采用5例成人下肢皮瓣解剖，灌注红色乳状液，研究皮瓣血供情况。在放大镜下观察足部近蒂穿支筋膜皮瓣血供来源，游标卡尺测量穿支血管口径。②方法在解剖研究的基础上，设计邻近穿支筋膜皮瓣修复足底缺损。应用皮瓣治疗植物缺损11例，其中恶性黑色素瘤5例，难治性创面5例，色素痣1例。缺陷尺寸为1.5 cm×2.0 cm ~ 4.0 cm ×5.0 cm，皮瓣尺寸为7.0 cm×3.0 cm ~ 13.0 cm×7.0 cm。结果解剖研究表明，足底间隙穿支附近筋膜皮瓣的供血血管为足底内侧动脉。外径大于或等于0.5 mm穿通数约7个，平均外径为(0.85±0.19)mm。足底内侧动脉沿跑行方向发出多支，在足弓处形成吻合支，保证皮瓣供血。11例穿支筋膜皮瓣成活，其中1例远端小面积坏死，换药后愈合。随访6 ~ 24个月，患者行走正常，肌理完整，无局部钝痛。结论根据病变程度，投影邻近穿支筋膜皮瓣，缺损皮肤质地相近的皮瓣可提高其耐磨性和耐磨性。供区可直接闭合，无需植皮。它是修复中小型足底缺损的一种简便、可靠的方法。关键词:足底;穿支皮瓣、筋膜皮瓣;应用解剖学;修复

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Anatomic feature of the adjacent perforator fasciocutaneous flap of plantar and its clinical application

Objective To study the anatomic basis and its clinical effects of the adjacent perforator fasciocutaneous flap in planta. Methods From October, 2010 to December, 2017, the work was on two fronts:① The blood supply of the flap was studied by the dissection of 5 adult lower limbs which were perfused with red emulsion. Under the magnifying glass, the source of blood supply to the pedicle perforator fasciocutaneous flap near the foot was observed, and the caliber of perforating vessels was measured by vernier caliper. ② Methods based on the anatomic study, the adjacent perforator fasciocutaneous flap was designed to repair plantar defect. Eleven cases with defects in planta were treated with the flap including 5 malignant melanoma, 5 refractory wound and 1 pigmented nevus. The size of defects ranged from 1.5 cm×2.0 cm to 4.0 cm ×5.0 cm with the size of the flaps ranging from 7.0 cm×3.0 cm to 13.0 cm×7.0 cm. Results Anatomical studies showed that the supply vessels of the fasciocutaneous flap near the perforator of the plantar space were plantar medial arteries. The external diameter was greater than or equal to the 0.5 mm perforating number of about 7, the average outer diameter was (0.85±0.19) mm. The medial plantar artery emits multiple branches along the running direction and forms anastomotic branches in the arch of the foot to ensure the blood supply of the flap. Eleven cases of perforator fasciocutaneous flaps survived, including 1 case of distal necrosis of small area and healed after change dressings. The follow-up results during 6-24 months showed that all patients were walking normally, with full texture and no localized dull pain. Conclusion On the basis of the extent of diseases, projected the adjacent perforator fasciocutaneous flap, the wear resistance and abrasive resistance are improved resulted from flaps with similar skin texture of defects. The donor site can be closed directly without skin graft. It is an simple and reliable method to repair medium and small- sized plantar defects. Key words: Plantar; Perforator flap, fasciocutaneous flap; Applied anatomy; Repair

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来源期刊

中华显微外科杂志

CiteScore

0.50

自引率

0.00%

发文量

6448

期刊介绍： Chinese Journal of Microsurgery was established in 1978, the predecessor of which is Microsurgery. Chinese Journal of Microsurgery is now indexed by WPRIM, CNKI, Wanfang Data, CSCD, etc. The impact factor of the journal is 1.731 in 2017, ranking the third among all journal of comprehensive surgery. The journal covers clinical and basic studies in field of microsurgery. Articles with clinical interest and implications will be given preference.