Zhang T, Cheng J N, Yang L, Sun F W, Gao Q F, Huang Y T, Yang C P, Cao Y, Liu Z J, Ju J H
Department of Hand Surgery, Suzhou Ruihua Orthopaedic Hospital, Suzhou 215104, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2023 Jul 20;39(7):655-661. doi: 10.3760/cma.j.cn501225-20220930-00428.
To investigate the therapeutic efficacy of bilobated superficial peroneal artery perforator flap in repairing two adjacent wounds of the fingers. A retrospective observational study was conducted. From January 2021 to January 2022, 15 patients with two adjacent wounds of the fingers who met the inclusion criteria were hospitalized in Suzhou Ruihua Orthopaedic Hospital, including 10 males and 5 females, aged 25 to 51 years. The area of single wound after debridement was from 2.5 cm×2.0 cm to 7.5 cm×2.5 cm. All the wounds were repaired by the bilobated superficial peroneal artery perforator flap from the lower leg. The single lobe area of bilobated flap was from 3.0 cm×2.0 cm to 8.0 cm×3.0 cm. The wounds in all the donor sites were sutured directly. During the operation, the number of resected flaps, the number and type of carried perforators were recorded, and the calibers of perforator and superficial peroneal artery and the length of vascular pedicle were measured. The survival of flap and the wound healing in the donor and recipient sites were recorded after operation. The recovery of donor and recipient sites were recorded during follow-up. At the last follow-up, the repair effect of flap was evaluated by the comprehensive evaluation scale, and the sensory function of flap was evaluated by the sensory function evaluation standard of British Medical Research Association. During the operation, 15 bilobated flaps were successfully resected, carrying 36 superficial peroneal artery perforators, all of which were septocutaneous perforators with the caliber of 0.2-0.8 mm. The caliber of superficial peroneal artery was 0.4-1.1 mm and the length of vascular pedicle was 3-8 cm. After operation, all the flaps survived with no vascular crisis occurred, and the wounds in donor and recipient sites healed well. During the follow-up of 6 to 12 months, the color and texture of flaps were similar to those of normal tissue in the hand and the appearance of flap was good in 10 cases; the other 5 cases underwent the stage Ⅱ flap thinning and plastic surgery 6 months after operation due to the bloated appearance of flaps. There was only linear scar in the donor site of lower leg, with no obvious scar hyperplasia or pigmentation, and there was no obvious adverse effect on the sensation or motor function of the distal limbs in the donor area. At the last follow-up, the repair effect of flap of 15 patients was excellent in 11 cases and good in 4 cases, and the sensory function of the flap was evaluated as grade S in all cases. The bilobated superficial peroneal artery perforator flap has high proportion of septocutaneous perforator, and the blood supply is sufficient and reliable. Using this flap to repair two adjacent wounds of the fingers causes minimal damage to the donor area, only one group of blood vessels is needed to be anastomosed to repair two wounds, the difficulty of microoperation is reduced, and good flap repair effect and sensory function can be obtained.
探讨双叶型腓浅动脉穿支皮瓣修复手指相邻双创面的治疗效果。进行一项回顾性观察研究。2021年1月至2022年1月,苏州瑞华骨科医院收治符合纳入标准的手指相邻双创面患者15例,其中男10例,女5例,年龄25~51岁。清创后单创面面积为2.5 cm×2.0 cm至7.5 cm×2.5 cm。所有创面均采用小腿双叶型腓浅动脉穿支皮瓣修复。双叶皮瓣单叶面积为3.0 cm×2.0 cm至8.0 cm×3.0 cm。所有供区创面均直接缝合。术中记录切取皮瓣数量、携带穿支数量及类型,测量穿支、腓浅动脉管径及血管蒂长度。术后记录皮瓣存活及供、受区创面愈合情况。随访期间记录供、受区恢复情况。末次随访时,采用综合评价量表评估皮瓣修复效果,采用英国医学研究协会感觉功能评价标准评估皮瓣感觉功能。术中成功切取15个双叶皮瓣,携带36支腓浅动脉穿支,均为肌间隔皮穿支,管径0.2~0.8 mm。腓浅动脉管径0.4~1.1 mm,血管蒂长度3~8 cm。术后皮瓣全部存活,未发生血管危象,供、受区创面愈合良好。随访6~12个月,10例皮瓣颜色、质地与手部正常组织相似,外观良好;另5例术后6个月因皮瓣臃肿行Ⅱ期皮瓣修薄整形手术。小腿供区仅留线性瘢痕,无明显瘢痕增生及色素沉着,对供区远端肢体感觉及运动功能无明显不良影响。末次随访时,15例患者皮瓣修复效果优11例,良4例,皮瓣感觉功能均评定为S级。双叶型腓浅动脉穿支皮瓣肌间隔皮穿支比例高,血供充足可靠。采用该皮瓣修复手指相邻双创面,对供区损伤小,修复两个创面仅需吻合一组血管,减少了显微手术难度,可获得良好的皮瓣修复效果及感觉功能。