Schierle Clark F, Rawlani Vinay, Galiano Robert D, Kim John Y S, Dumanian Gregory A
Chicago, Ill. From the Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University.
Plast Reconstr Surg. 2009 Jun;123(6):1748-1754. doi: 10.1097/PRS.0b013e3181a65a74.
The reliability of the distally based pedicled hemisoleus flap for coverage of relatively small medial distal third leg wounds has been continuously debated among reconstructive surgeons. Whereas some authors report that the distally based hemisoleus can be elevated safely, other authors argue that the flap's retrograde blood supply is problematic. The authors believe that application of angiosome principles may help surgeons to better design the distally based hemisoleus flap such that outcomes are optimized.
Seventeen patients received a distally based hemisoleus flap for coverage of a small distal third leg wound. Flaps were designed to capture one full angiosome and only a portion of the adjacent angiosome.
Reliable soft-tissue coverage and wound healing were achieved in all patients. Mean operative time of 130 minutes reflected the relative technical ease and efficiency of the surgery. Only one patient suffered distal tip flap necrosis, which did not compromise soft-tissue coverage and ultimately resulted in a healed wound and fracture.
The distally based hemisoleus flap is an efficacious method of treating small distal third medial tibial wounds. Flap design based on vascular perforator angiosome principles may help surgeons improve the reliability of this flap.
对于以远端为蒂的半腱肌皮瓣用于覆盖小腿远端内侧相对较小的伤口的可靠性，重建外科医生一直存在争议。一些作者报告说，以远端为蒂的半腱肌皮瓣可以安全掀起，而其他作者则认为该皮瓣的逆行血供存在问题。作者认为，应用血管体原则可能有助于外科医生更好地设计以远端为蒂的半腱肌皮瓣，从而优化治疗效果。
17例患者接受了以远端为蒂的半腱肌皮瓣来覆盖小腿远端内侧的小伤口。皮瓣设计为包含一个完整的血管体及相邻血管体的一部分。
所有患者均获得可靠的软组织覆盖和伤口愈合。平均手术时间为130分钟，体现了该手术相对简便和高效。仅1例患者出现皮瓣远端坏死，但未影响软组织覆盖，最终伤口愈合，骨折处也愈合。
以远端为蒂的半腱肌皮瓣是治疗小腿远端内侧小伤口的有效方法。基于血管穿支血管体原则的皮瓣设计可能有助于外科医生提高该皮瓣的可靠性。
