应用第一跖背动脉逆行岛状皮瓣修复第一足趾软组织缺损.docVIP

应用第一跖背动脉逆行岛状皮瓣修复第一足趾软组织缺损 　　【摘要】 目的：探讨第一跖背动脉逆行岛状皮瓣修复第一足趾软组织缺损的临床应用。方法：应用第一跖背动脉逆行岛状皮瓣修复第一足趾软组织缺损15例，其中趾背缺损4例，趾端缺损6例，趾腹缺损5例。切取面积2 cm×3 cm～4 cm×5 cm。供区行游离植皮。术后予抬高患肢、保暖、抗感染、抗痉挛、抗凝、镇痛等治疗，随访2～12个月。结果：术后15例皮瓣全部存活，皮瓣无明显臃肿，无色素沉着，弹性好，患肢无跛行，穿鞋或行走均不受限制，对患者进行美国足踝矫形协会的足踝评分（AOFAS评分），分值在80分以上。结论：第一跖背动脉逆行岛状皮瓣血管解剖比较恒定，有良好的血运，是一种修复第一足趾软组织缺损的较好的方法 【关键词】 第一跖背动脉； 岛状皮瓣； 第一足趾； 软组织缺损 【Abstract】 Objective：To investigate the clinical application for the first dorsal metatarsal artery flap to repair the soft tissue defect of the first toe.Method：A total of 15 patients were using the first dorsal metatarsal artery retrograde island flap for repairing the first toe soft tissue defect，including 4 cases of dorsal defect，6 cases of toe defect and 5 cases of toe pulp defect，whose cutting area was （2 cm×3 cm）-（4 cm×5 cm）.The supply of skin flap area was using free skin grafting.All patients raise wounded limb，keep limb warm，treated by using anti infection，anti spasm，anti coagulation and analgesia after the operation.After 2-12 months of follow-up.Result：All of the 15 patients，whose flaps had survived，no significant flap bloated appearance，no skin pigmentation，good elasticity，no limb claudication，walking or/and wearing shoes was not restricted after clinical recovering.For patients with foot and ankle ankle Orthopedic Association score，score more than 80 points.Conclusion：The first dorsal metatarsal artery retrograde island flap has a good blood supplying， and based on the stable vascular anatomy， which is one of the better method to repair soft tissue defect of the first toe. 【Key words】 The first dorsal metatarsal artery； Island flap； The first toe； Soft tissue defect First-authors address：Guangdong Medical University，Zhanjiang 524023，China doi：10.3969/j.issn.1674-4985.2016.32.014 足趾?组织缺损在临床上比较常见，由于足部皮肤软组织较薄，缺损后常合并骨、关节、肌腱及神经血管等的外露，传统的皮片移植、局部随意型皮瓣等方法不太适宜，因此创面修复较为棘手。近些年修复足部软组织缺损常用腓肠神经营养带蒂岛状皮瓣、足底内侧皮瓣、小腿内侧筋膜蒂皮瓣、踝前皮瓣以及各种改良微型皮瓣等手术方法[1]。由于第一足趾皮肤软组织缺损的创面相对较小且离中心偏远，应用上述方法修复时相对困难且对患者术后的外观及功能活