标题：胫后动脉穿支皮瓣与腓肠神经营养血管皮瓣修复小腿远端创面的效果比较

      作者：周 钢，邱勋永，王快胜，马心赤，王和驹
    （海南省人民医院骨科，海南 海口 570311）

      卷次： 2013年24卷9期

      【摘要】 目的 比较胫后动脉穿支皮瓣与腓肠神经营养血管皮瓣修复小腿远端及足踝部分软组织缺损的
术后患处外观及功能改变。方法 2009年 8月至 2012年 2月收治 52例足、踝以及远端小腿皮肤软组织缺损患
者，使用胫后动脉穿支皮瓣修复25例，腓肠神经营养血管皮瓣修复27例，术后对并发症发生率进行统计，并于术
后 6个月复查时使用改良Weber临床缺陷评分系统对患肢的功能进行评估。结果 微小皮瓣坏死(<10%)发生
率：胫后动脉穿支皮瓣为8.7%，腓肠神经营养血管皮瓣为12.0%；部分皮瓣坏死(≥10%)发生率：胫后动脉穿支皮
瓣为8.7%，腓肠神经营养血管皮瓣为4.0%。完全坏死仅腓肠神经营养血管皮瓣组发生2例。改良Weber临床缺
陷评分：胫后动脉穿支皮瓣组(6.17±1.35)分，腓肠神经营养血管皮瓣组（8.92±1.73）分，但仅在“肿胀”项评分比较
中具有统计学意义(P<0.05)。结论 胫后动脉穿支皮瓣术后受区外观较好，对供区功能改变影响较小，而术后发
生坏死的风险也并不高于传统的腓肠神经营养血管皮瓣，因此可以作为小腿远端、足、踝部分中、小面积皮肤软
组织缺损的首选治疗方案。

      【关键词】 下肢软组织缺损；胫后动脉穿支皮瓣；腓肠神经营养血管皮瓣；创面修复

      【中图分类号】 R687.1 【文献标识码】 A 【文章编号】 1003—6350（2013）09—1293—04


Comparison between posterior tibial artery perforator flaps and sural flaps for reconstruction of foot, ankle
and distal lower leg.
ZHOU Gang, QIU Xun-yong, WANG Kuai-sheng, MA Xin-chi, WANG He-ju. Department of
Orthopedics, Hainan Provincial People's Hospital, Haikou 570311, Hainan, CHINA

【Abstract】 Objective To compare cosmetic and functional outcome following transfer of posterior tibial ar-
tery perforator flaps and sural flaps for reconstruction of foot, ankle and distal lower leg. Methods Fifty-two patients
with skin defects of the foot, ankle and distal lower leg from August 2009 to February 2012 were enrolled in this
study, of which 25 were treated with posterior tibial artery perforator flaps and 27 with sural flaps. The incidence of
postoperative complications were observed, and the leg function of patients was evaluated 6 months after treatment us-
ing modified Weber scale. Results Minor flap necrosis (<10%) was observed in 8.7% of the posterior tibial artery
perforator flaps and 12.0% of the sural flaps, and partial necrosis (≥10%) was observed in 8.7% of the posterior tibial
artery perforator flaps and 4.0% of the sural flaps. Total flap loss only occurred in 2 patients following transfer of sural
flaps. Although the mean total score of the modified Weber scale of the posterior tibial artery perforator flaps was low-
er, but the difference was only significant in the Swelling subscale. Conclusion The incidence of flap necrosis and
the morbidity in the donor of the posterior tibial artery perforator flaps was not greater than sural flap, but the former
has a better aesthetic. The posterior tibial artery perforator flap should be recommended for reconstruction of small-to
medium-sized defects at the foot, ankle and distal lower leg.

      【Key words】 Posterior tibial artery perforator flap; Sural flap; Soft tissue defect of lower extremity; Wound repair