摘要目的 探讨运用外增压技术的腓动脉穿支皮瓣修复足踝软组织缺损的技术要点及临床效果.方法 2010年1月至2018年2月,共采用外增压腓动脉穿支螺旋桨皮瓣修复足踝软组织缺损10例,病因:创伤7例,慢性伤口溃疡1例,跟骨手术切口愈合不良2例.缺损部位:足跟5例,内、外踝部2例,足背及足底3例.皮瓣大小6.0 cm×3.0 cm～16.0 cm×5.0 cm.术后1、3、6个月来院复诊随访,术后3个月时按照美国矫形外科足踝协会(AOFAS)踝-后足评分系统进行功能评定.2016年11月至2017年5月,利用新鲜尸体标本对外增压腓动脉穿支皮瓣的解剖基础及手术操作要点进行研究总结.结果 10例外增压腓动脉穿支皮瓣全部成活,其中2例术后皮瓣近端出现局部表皮坏死,经过1～2周换药后最终愈合,其余8例愈合良好.解剖研究显示,不同平面的外增压腓动脉穿支螺旋浆皮瓣的只有采用不同旋转方向旋转才能减少双蒂互相压迫,减少皮瓣远端坏死率.结论 外增压腓动脉穿支螺旋桨皮瓣可增强皮瓣“大桨”动脉供血及静脉回流,有效减少皮瓣远端坏死率.

abstractsObjective To explore the clinical technical points of the treatment of soft tissue defect of the foot and ankle with the supercharged peroneal artery perforator propeller flap,and to provide theoretical support by anatomical observation.Methods From January,2010 to February,2018,a total of 10 patients with soft tissue defect of foot and ankle were treated with supercharged peroneal artery perforator propeller flap.Cause of injury:trauma in 7 cases,wound ulcer in 1 case,and poor healing of the calcaneus incision in 2 cases.Defect site:5 cases of heel,2 cases of medial and lateral malleolus,and 3 cases of dorsum and sole.The size of flap ranged from 6.0 cm×3.0 cm to 16.0 cm×5.0 cm.All patients were followed-up at 1,3,6 months after operation,and the function recovery was judged by AOFAS Ankle Hindfood Scale at 3 months post-opertively.From November,2016 to May,2017,the anatomical basis and operative points of the supercharged peroneal artery perforator flap were summarized.Results All the 10 cases of supercharged peroneal artery perforator propeller flap survived.Two of them had local epidermal necrosis at the proximal end of the flap.After 1 to 2 weeks of dressing,they finally healed.The other 8 cases healed well.Anatomical studies showed that different planes of the supercharged peroneal artery perforator propeller flap can only reduce the compression of the double pedicles and reduce the distal necrosis rate of the flap by rotating in different rotation directions.Conclusion The supercharged peroneal artery perforator propeller flap can enhance the blood supply and venous return in the "big paddle" artery of the flap,preventing distal necrosis.