Objective: To investigate the effectiveness of abdominal free flap carrying bilateral superficial circumflex iliac arteries for repairing large skin and soft tissue defects of foot and ankle.
Methods: Between June 2016 and June 2019, 15 patients with large skin and soft tissue defects of foot and ankle were admitted, including 10 males and 5 females with an average age of 30 years (range, 10-60 years). The causes of injury included 6 cases of traffic accident, 3 cases of machine strangulation, 3 cases of heavy object injury, 2 cases of fall, and 1 case of electric shock. The time from injury to admission was 3 hours to 10 days, with an average of 2 days. The wound located at dorsal foot in 5 cases, ankle in 6 cases, dorsal foot and ankle in 3 cases, and dorsal foot and sole in 1 case. All wounds were contaminated to varying degrees and accompanied by tendon and bone exposure, including 5 cases of extensive necrosis of the dorsal skin with infection. The area of defects ranged from 18 cm×6 cm to 25 cm×8 cm. There were 9 cases of foot and ankle fractures and dislocations, and 2 cases of foot and ankle bone defects. The wound was repaired with abdominal free flap carrying bilateral superficial circumflex iliac arteries. The area of the flaps ranged from 20 cm×8 cm to 27 cm×10 cm; the skin flaps were thinned under the microscope to make the thickness of 0.5-1.0 cm, with an average of 0.7 cm. All incisions at the donor site were sutured directly.
Results: During the operation, 1 case was replaced with an abdominal free flap carrying the superficial abdominal artery because the superficial iliac circumflex artery was thin and the superficial abdominal artery was thicker. The skin flaps of 15 cases survived smoothly, and the wounds healed by first intention; the donor incisions all healed by first intention. All patients were followed up 8-36 months, with an average of 15 months. The flap shape was satisfactory, with good texture and mild pigmentation of the flap edge, without obvious bloating, effect on shoe wear, or secondary surgical thinning of the flap. The linear scar left in the donor site and had no effect on hip joint movement. All fractures healed well, and the healing time ranged from 3 to 8 months, with an average of 6 months.
Conclusion: The abdominal free flap carrying bilateral superficial iliac circumflex arteries has concealed donor site, with little damage, and can be sutured in one stage. The blood vessel is anatomically constant, with less variation, and reliable blood supply. It is one of the ideal flaps for repairing large skin and soft tissue defects of foot and ankle.
目的: 探讨携带双侧旋髂浅动脉的腹部游离皮瓣修复足踝部大面积皮肤软组织缺损的临床疗效。.
方法: 2016 年 6 月—2019 年 6 月收治 15 例足踝部大面积皮肤软组织缺损患者，男 10 例，女 5 例；年龄 10～60 岁，平均 30 岁。致伤原因：交通事故伤 6 例，机器绞伤 3 例，重物砸伤 3 例，摔伤 2 例，电击伤 1 例。受伤至入院时间 3 h～10 d，平均 2 d。创面部位：足背 5 例，踝部 6 例，足背及踝部 3 例，足背及足底 1 例。创面均有不同程度污染且伴有肌腱及骨外露，其中 5 例足背皮肤大面积坏死伴感染。创面范围为 18 cm×6 cm～25 cm×8 cm。伴有足踝部骨折及脱位 9 例，足踝部骨缺损 2 例。采用携带双侧旋髂浅动脉的腹部游离皮瓣修复创面，皮瓣切取范围为 20 cm×8 cm～27 cm×10 cm；显微镜下修薄皮瓣，使其厚度为 0.5～1.0 cm，平均 0.7 cm。供区切口均直接缝合。.
结果: 术中 1 例因旋髂浅动脉较细而腹壁浅动脉较粗，改行携带腹壁浅动脉的腹部游离皮瓣修复。15 例皮瓣均顺利成活，创面Ⅰ期愈合；供区切口均Ⅰ期愈合。患者均获随访，随访时间 8～36 个月，平均 15 个月。皮瓣外形满意，无明显臃肿，质地良好，不影响穿鞋，无需二次手术修薄皮瓣，仅皮瓣边缘有轻度色素沉着。供区遗留线性瘢痕，对髋关节活动无影响。伴有骨折者均愈合良好，愈合时间 3～8 个月，平均 6 个月。.
结论: 携带双侧旋髂浅动脉的腹部游离皮瓣供区较隐蔽，损伤小，可一期缝合，血管解剖恒定，变异少，血供可靠，是修复足踝部大面积皮肤软组织缺损的理想皮瓣之一。.
Keywords: Foot and ankle; abdominal free flap; soft tissue defect; superficial iliac circumflex arteries; wound repair.