Resurfacing Soft Tissue Defect of Distal Limb Using Perforator Flap from the Lateral Leg Area

小腿外側穿通枝皮瓣重建四肢軟組織缺損

蒲啟明(Chi-Ming Pu) ； 鄧修國(Hsiu-Gwo Teng) ； 袁聖哲(Ted Sheng-Che Yuan) ； 郭宇正(Yu-Chen Kuo) ； 王君瑜(Chun-Yu Wang) ； 林莉穎(Li-Ying Lin) ； 顏毓秀(Yu-Hsiu Yen)

《臺灣整形外科醫學會雜誌》 21卷3期 (2012/09) Pp. 169-179

https://doi.org/10.7096/TJTSPS.201209.0169

摘要

背景：近幾年由於顯微手術的進步，各種不同的皮瓣發展迅速。穿通枝皮瓣在取下時對於組織有較少的傷害，因此也成為重建手術中的重要皮瓣之一。目的及目標：四肢末端的軟組織缺損常常造成韌帶、骨頭及血管等重要構造的暴露，必須使用局部皮瓣或游離皮瓣來覆蓋傷口，另外考慮到外觀上的問題，四肢末端的軟組織缺損最好以較薄的皮瓣來重建。而穿通枝皮瓣有手術時間較短、皮瓣較薄以及對供應區組織傷害較少…等許多好處，因此在許多重建顯微手術經常被運用。而本文乃探討小腿外側穿通枝皮瓣是否適用於四肢末端軟組織缺損的重建？材料及方法：從2010年6月到2011年5月，我們收集了六位利用小腿外側穿通枝皮瓣重建四肢末端軟組織缺損的患者，其中四位為上肢軟組織缺損的患者，其餘兩位有下肢軟組織缺損。我們術前使用Dopplerprobe先定位小腿外側近端及中段穿通枝的位置，再沿著穿通枝的位置逆向沿著肌肉間仔細的分離出穿通枝血管直到源頭，並且以顯微手術方法將皮瓣轉移至軟組織缺損的區域，此外取得皮瓣的小腿部分均可直接縫合不須植皮。結果：其中一位患者的皮瓣因為重建區血流量的不足而造成皮瓣壞死，其餘五位患者皮瓣均成功存活，並且得到滿意的外觀及功能的重建。所有小腿外側穿通枝皮瓣的供應區均直接縫合，外觀上只留下一條患者可接受的疤痕。結論：小腿外側穿通枝皮瓣因為較薄且柔軟適合使用於重建四肢末端軟組織缺損，但是它的缺點包括：穿通枝的直徑較小需要較好的顯微手術技術而且血管的長度也比較短。

並列摘要

Background: Perforator flap from lateral leg area is a newly developed flap in recent years. Is it suitable for the reconstruction of distal limb soft tissue defect? Aim and Objectives: Soft tissue defect of the distal limb is a common problem encountered in our daily practice. When tendons, bones, vessels or other major structures are exposed, a vascularized flap is mandatory to resurface the defect and cover the exposed structures. Reconstructive options for soft tissue defect of the extremity include local and free flaps. There are many kinds of flaps described previously in the literatures and each has its advantages and disadvantages. Perforator flap is a type of free flaps that has advantages such as minimal donor site morbidity, short harvesting time etc. It has gained increasing popularity in the modern microsurgical operation. A thin and pliable flap is most suitable for resurfacing defect in the extremity to avoid deformed and bulky appearance after reconstruction. Perforator flap from the lateral leg is a choice in the reconstruction of soft tissue defect of the distal limb. Here we describe our experience in resurfacing soft tissue defect of the distal limb using perforator flap harvested from lateral lower leg. Materials and Methods: We collected data from six patients with soft tissue defect of the distal limb, reconstructed with lateral leg perforator flaps from Jun 2010 to May 2011. Four upper extremities and two lower extremities reconstruction cases were included. Hand-held Doppler probe was used preoperatively to identify the perforators in the proximal or middle lateral lower leg area. Based on the perforators identified preoperatively, we harvested the flap meticulously, dissected the pedicle in a retrograde fashion and source vessels were reached. We also prepared the recipient site for microvascular anastomosis. Donor sites, the lateral leg areas were closed primarily in all six cases. Results: There is one flap loss in a case of lower extremity reconstruction. The other five flaps survived without any complications. Inevitably, linear scar formed over the lateral lower leg area. None was dissatisfied regarding the scar or esthetic appearance of the donor site. All successful cases reported satisfaction with the aesthetic and functional results of the reconstructed hand or foot.Conclusions: Perforator flap from the lateral lower leg area is a reliable flap with thin and pliable skin, making it suitable for resurfacing soft tissue defect in distal limb. Disadvantages of the flap include small calibre perforator, need for meticulous dissection technique and relatively short pedicle length. (J Taiwan Soc of Plast Surg 2012;21:169晋179)

並列關鍵字

distal limb ； soft tissue defect ； lateral leg perforator flap