探讨带蒂腓肠内侧动脉或联合胫后动脉多穿支皮瓣修复小腿创面的临床应用。

2012年1月至2021年12月，选取广东医科大学附属医院整形外科小腿创面患者13例(共14处创面)，男9例，女4例。年龄6.0~75.0岁，平均年龄为(41.2±22.2)岁。膝部3例、腘窝2例(其中1例为双侧腘窝)、小腿上段3例、小腿中段2例和小腿下段3例。创面准备待局部血供良好、感染较轻时予皮瓣修复术，创面面积为4.0 cm×3.0 cm~21.0 cm×5.5 cm。以腘窝中点与内踝中点连线为皮瓣轴线，腘窝下约8 cm和15 cm为穿支血管位置，以此设计皮瓣。行切口探查技术定位穿支血管位置后，根据小腿创面位置、大小及形状选择合适的带蒂腓肠内侧动脉或联合胫后动脉多穿支皮瓣。术后给予常规抗炎、抗凝及解痉等治疗。观察并记录术后皮瓣成活情况、伤口愈合时间。通过门诊随访记录受区及供区的外形、质地及功能恢复情况。

13例患者14处皮瓣修复。蒂部穿支血管数目2支者9例，3支者5例；螺旋桨皮瓣5例，皮瓣面积大小为11.2 cm×3.2 cm~20.0 cm×5.5 cm；V-Y推进皮瓣9例，面积大小为8.0 cm×5.0 cm~20.0 cm×11.0 cm。2例患者术后皮瓣尖端淤血，均自行缓解。14处皮瓣均成活，所有创面得到有效修复，平均愈合时间为(14.5±1.7) d，随访时间为13.0(2.5，26.5)个月。所有患者皮瓣颜色、质地良好，外形无臃肿，与周围皮肤接近，功能良好。供区愈合良好，未见明显功能障碍。

带蒂腓肠内侧动脉或联合胫后动脉多穿支皮瓣的血供更为可靠、伤口愈合能力更强。可根据创面的位置、形状及大小，灵活设计皮瓣，扩大其适应证。该皮瓣在修复除踝前区之外的小腿创面中具有较大的推广价值。

To investigate the clinical application of pedicled medial sural artery or combined posterior tibial artery multiple perforator flap in the repair of lower leg wound.

From January 2012 to December 2021, a total of 14 wounds were selected from 13 patients with lower leg wound in the Department of Plastic Surgery, Affiliated Hospital of Guangdong Medical University, including 9 males and 4 females. The average age was (41.2±22.2) years, ranging from 6.0 to 75.0 years. There were 3 cases in the knee, 2 cases in the popliteal fossa (1 of which was bilateral popliteal fossa), 3 cases in the upper leg segment, 2 cases in the middle leg segment and 3 cases in the lower leg segment. When the local blood supply was good and the infection was mild, the flap was repaired. The area of the wound was 4.0 cm×3.0 cm-21.0 cm×5.5 cm.The flap was designed by taking the line between the midpoint of the popliteal fossa and the midpoint of the medial malleolus as the axis of the flap, and about 8 cm and 15 cm below the popliteal fossa as the locations of the perforating vessels. After the perforator vessel location was determined by the incision exploration technique, the pedicled medial sural artery or combined posterior tibial artery multiple perforator flaps were selected according to the location, size and shape of the lower leg wound. After operation, conventional anti-inflammation, anticoagulation and spasmolytic treatment were given. The survival of flap and wound healing time were observed and recorded. The appearance, texture and functional recovery of the recipient and donor areas were recorded by outpatient follow-up.

There were 14 flap repairs in 13 patients. The number of pedicle perforating vessels was 9 cases with 2 vessels and 5 cases with 3 vessels. Propeller flaps were found in 5 cases, and the flap area was 11.2 cm×3.2 cm-20.0 cm×5.5 cm. There were 9 cases of V-Y propulsion flaps, the size of which was 8.0 cm×5.0 cm-20.0 cm×11.0 cm. Postoperative congestion in the tip of the flap was resolved in 2 patients. All the 14 flaps survived and all the wounds were effectively repaired. The mean healing time was (14.5±1.7) d, and the follow-up was 13.0(2.5, 26.5) months. The skin flap of all patients had good color and texture, no bloatiness in appearance, and was close to the surrounding skin with good function. The donor area healed well and no obvious dysfunction was observed.

Pedicled medial sural artery or combined posterior tibial artery multiple perforator flap has more reliable blood supply and better wound healing ability. According to the location, shape and size of the wound, the flap can be flexibly designed to expand its indications. The flap is of great value in the repair of lower leg wounds except the anterior ankle area.