Axial Choke Vessel Design of Posterior Tibial Artery Perforator-Based Propeller Flap for Lower Extremity Reconstruction

以軸向隱蔽血管設計的後脛動脈穿通枝螺旋槳皮瓣重建下肢缺損

劉宗憲(Tsung-Hsien Liu) ； 謝孟謙(Meng-Chien Hsieh) ； 黃書鴻(Shu-Hung Huang) ； 賴春生(Chung-Sheng Lai) ； 林幸道(Sin-Daw Lin) ； 郭耀仁(Yur-Ren Kuo) ； 張智豪(Chih-Hau Chang)

《臺灣整形外科醫學會雜誌》 30卷1期 (2021/03) Pp. 1-9

摘要

Background: Blood supply to the lower extremities align along with our limb long axis. Theoretically, choke vessels distribute evenly between two neighboring perforators. Therefore, a longitudinal design of propeller flap parallel to the long axis of the leg could include maximal choke vessels and ensure the viability of perforator-based propeller flap. Aim and Objectives: The aim of this study is to present and validate the reliability of using axial choke vessel design of the posterior tibial artery perforator-based propeller flap to reconstruct lower extremity defects complicated by bone or hardware exposure. Materials and Methods: Eight patients who received axial choke vessel design of posterior tibial artery perforator-based propeller flap for lower leg defects reconstruction during April 2016 to April 2018 at Kaohsiung Medical University Chung-Ho Memorial Hospital were enrolled in this study. The survival of flaps as well as long-term complications were evaluated via a retrospective review of the medical records. Results: The width-to-length ratio of the propeller flaps were 1:4 for four patients, 1:4.8 for one patient and 1:5 for the other three patients. Complete flap survival was observed in the group with width-to-length ratio of 1:4 for the propeller flaps. Partial distal tip or margin loss were noted in whom the width-to-length ratio of the flaps exceeded than 1:4. The remaining minor wound healed after meticulous wound care. Conclusion: Axial choke vessel design of posterior tibial artery perforator-based propeller flap with width-to-length ratio of 1:4 proves to be a safe alternative reconstructive choice for lower leg defects. This longitudinal skin paddle design not only extends the versatility of the propeller flap for lower leg reconstruction but also simultaneously decreases donor site morbidity, thereby allowing easier primary closure.

關鍵字

lower leg reconstruction ； propeller flap ； choke vessel

並列摘要

背景：下肢血管及血流走向是沿著下肢的長軸分佈。理論上，隱蔽血管會在兩個穿通枝血管間平均分佈，因此沿著下肢長軸設計的縱向螺旋槳皮瓣可以涵括最多的隱蔽血管，並確保其皮瓣可獲得充足的血流供應。目的及目標：此篇文章的目的在於報告及驗證以軸向隱蔽血管設計的後脛動脈穿通枝螺旋槳皮瓣，重建下肢內側缺損合併骨頭或內固定物暴露的可靠性。材料及方法：此篇論文收集在高雄醫學大學附設中和紀念醫院從2016年4月至2018年4月間，總共八位病患以軸向隱蔽血管設計的後脛動脈穿通枝螺旋槳皮瓣，重建下肢軟組織缺損合併骨頭或內固定物暴露的傷口，以病歷回顧的方式評估皮瓣重建的存活率及後續長期的併發症。結果：四位患者的螺旋槳皮瓣寬長比是1：4，一位患者的皮瓣寬長比是1：4.8，另外三位患者的皮瓣寬長比是1：5。其中寬長比為1：4的螺旋槳皮瓣存活率為百分之百；寬長比大於1：4的病患中，有發生小部分皮瓣最遠端或邊緣損失，而剩餘的微小缺損在傷口換藥下後續都有癒合。結論：以寬長比為1：4的軸向隱蔽血管設計的後脛動脈穿通枝螺旋槳皮瓣，重建下肢內側合併軟組織缺損及骨頭或內固定物暴露的傷口是個安全且可靠的替代方法。此縱向的皮瓣設計可以擴增螺旋槳皮瓣的可轉動性及用途，同時也減小供皮區的發病率增加直接縫合的可能。