陈黎明 徐立炜 刘毅 李超

[摘要]目的：探讨小腿前侧小面积深度创面的皮瓣修复方法。方法：2016年2月-2018年2月，笔者单位收治13例小腿前侧小面积深度创面患者，均采用自由穿支皮下蒂皮瓣推进修复，供区直接拉拢缝合。结果：12例皮瓣100%成活，1例皮瓣尾部因血运障碍，发生坏死，二期手术植皮修复。随访3～12个月，外形、功能恢复满意。结论：自由穿支皮下蒂皮瓣设计简单，供区无需植皮，修复后既保证小腿前侧有良好的组织保护，又可最大程度地维持小腿外形，是小腿前侧小面积深度创面的良好修复方法。

[关键词]自由穿支皮瓣;创面修复;“风筝样”三角皮瓣;胫前;骨外露;直接缝合

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2019）02-0021-02

Abstract： Objective  To explore the method of repairing small area wounds at the anterior side of the tibia with flaps. Methods  From February 2016 to February 2018， 13 patients with small-scale deep wounds on the front side of the calf were received and cured. They were treated with a freestyle perforator subcutaneous pedicle flap， and the donor area was directly sewed and sutured. Results  The flaps of 12 cases are 100% survived. Except one case with necrosis of the flaps tail was caused by ischemia and healed with subsequent skin grafting. The patients were followed up 3-12 months.The appearances and functions were satisfied. Conclusion  The design of the freestyle perforator subcutaneous pedicle flap is simple， and there is no need for skin grafting in the donor site. After repairing， it can ensure good tissue protection on the front side of the tibia and maintain the shape of the calf to the greatest extent. It is a good repair method for small area deep wound on the front side of the tibia.

Key words： free perforator flaps; wound repair; “kite-like” triangular flaps; anterior tibia; bone exposure; direct suture

小腿胫骨前侧又称“迎面骨”，是身体重要的攻击与防御部位，易受伤害。该部位皮下组织薄弱，血运差，受伤之后加之局部感染，常规换药不易愈合[1-2]。常规治疗方法是局部筋膜皮瓣+供瓣区植皮修复，但术后外形不佳[3-4]。2016年2月-2018年2月，笔者单位收治了13例小腿胫前创面患者，采用自由穿支皮下蒂皮瓣修复，取得了良好修复效果。

1  临床资料

本组13例，男9例，女4例;年龄14～68岁，平均年龄32.4岁;伤后3～24d入院;致伤原因：摔伤7例，车祸伤3例，烧伤3例;创面均位于小腿中1/3位置，创面大小2cm×2cm～4cm×6cm;8例位于胫骨边缘，5例胫骨外露。入院时均伴有不同程度的创面感染、创周炎。

2  治疗方法

针对创周炎明显的病例，入院后采用静脉输液抗感染、红光局部照射、抬高患肢、局部换药等处理，4～7d后炎症消退，无明显创周红肿后进行手术。……