Kneser U, Beier J P, Dragu A, Arkudas A, Horch R E
Plastisch- und Handchirurgische Klinik, Universitätsklinikum Erlangen, Erlangen, Deutschland.
Oper Orthop Traumatol. 2013 Apr;25(2):170-5. doi: 10.1007/s00064-012-0200-9.
Defect reconstruction at the distal lower extremity by transposition of a vascularised fasciocutaneous flap.
Reconstruction of defects at the lateral aspect of the middle and distal third of the lower leg, the lateral ankle and achilles tendon region.
Lesions or occlusion of the peroneal artery, traumatized skin and soft tissues at the donor site of the flap, deep vein thrombosis of the ipsilateral leg.
Preoperative localisation of the dominant perforator using Duplex or Doppler ultrasound or CT-angiography. Initially limited skin incision and identification and microsurgical dissection of the dominant perforator up to its origin from the peroneal artery. Completion of skin incision and mobilisation of the flap while the secondary perforans vessels are still preserved. Evaluation of flap perfusion and transfer of the flap into the defect by advancement or 180° rotation as a propeller flap. Closure of the donor site defect by direct suture or skin grafts.
Elevation of the extremity for 5 days. Elastocompressive garments and orthostatic training with increasing intensity. Standardised postoperative compression therapy and scar therapy if necessary.
Minimal functional donor site defect and optimal functional and aesthetic results.
通过带血管蒂的筋膜皮瓣移位修复下肢远端缺损。
修复小腿中下段外侧、外踝及跟腱区域的缺损。
腓动脉病变或闭塞、皮瓣供区皮肤及软组织创伤、同侧下肢深静脉血栓形成。
术前使用双功超声、多普勒超声或CT血管造影对主要穿支进行定位。最初做有限的皮肤切口，识别主要穿支并进行显微外科解剖，直至其从腓动脉发出处。在保留次要穿支血管的同时完成皮肤切口并掀起皮瓣。评估皮瓣血运，将皮瓣推进或180°旋转作为推进皮瓣转移至缺损处。直接缝合或植皮关闭供区缺损。
肢体抬高5天。使用弹力压缩衣并逐步增加强度进行体位训练。必要时进行标准化的术后加压治疗和瘢痕治疗。
供区功能缺损最小，功能和美学效果最佳。
