背景:在前足远端缺损中,发现伤口闭合是具有挑战性的,因为涉及远端部位和小血管。一种可能的解决方案是在“U型转弯”设计中使用meta动脉皮瓣。这种方法提供了几个优点,包括其长的长度和远端前足缺损的可行选择。
方法:连续招募36例因外伤而从meta趾(MTP)关节到远端指间(DIP)关节前足损伤的患者,并完成了研究。结果进行了描述性分析,并进行边缘坏死风险预测建模。
结果:平均±SD随访时间为27.3个月±1.9。MTP至DIP关节伤口宽度和长度的中位数(IQR)分别为1.8(1.4,3.0)和3.2cm(2.9,6.2),分别。中位数(IQR)宽度,长度,宽度与长度的比率为3.6(2.8,6.0),4.7cm(4.3,9.3),和1.5(1.2,1.7),分别。平均±SD手术时间为32.9min±5.7。术中出血量中位数(IQR)为5.0mL(4.0,5.0)。术后住院时间平均±SD为4.0天±1.0天。平均±SD足和踝关节结果评分和足功能指数分别为64.1±2.5和7.8%±3.3。所有患者均具有良好或优异的美学满意度。自发解决的边缘坏死发生率为13.9%。开始下床的平均±SD时间为1.7周±0.5。在为期两年的随访中,所有患者都减少了U形转弯皮瓣枢轴点冗余,没有鞋码影响,需要再次手术,或供体部位发病率。边缘坏死与长宽比(P=0.014)显着相关,但与脚和脚踝结果评分或脚功能指数无关。
结论:U型转弯设计的跖骨动脉皮瓣是可靠的,并且恢复时间短。由于手术时间短,前脚区域的替代分辨率,最小的失血,住院时间短,和出色的可用性。
BACKGROUND: In distal forefoot defect, finding wound closure is challenging because of the distal site and small blood vessels involved. One possible resolution is the utilization of a metatarsal artery flap in a \'U-turn\' design. This method offers several advantages, including its long length and a viable option for distal forefoot defect.
METHODS: Thirty-six patients with forefoot injuries from metatarsophalangeal (MTP) joint to distal interphalangeal (DIP) joint due to trauma were consecutively recruited and completed the study. Outcomes were analyzed descriptively, and risk prediction modeling for edge necrosis was performed.
RESULTS: The mean ± SD follow-up time was 27.3 months ±1.9. The median (IQR) MTP-to-DIP joint wound width and length were 1.8 (1.4, 3.0) and 3.2 cm (2.9, 6.2), respectively. The median (IQR) width, length, and width-to-length ratio flap dimensions were 3.6 (2.8, 6.0), 4.7 cm (4.3, 9.3), and 1.5 (1.2, 1.7), respectively. The mean ± SD operative time was 32.9 min ± 5.7. The median (IQR) intraoperative blood loss was 5.0 mL (4.0, 5.0). The mean ± SD hospital length of stay postoperatively was 4.0 days ±1.0. The mean ± SD Foot and Ankle Outcome Score and Foot Function Index were 64.1 ± 2.5 and 7.8% ± 3.3, respectively. All patients had good or excellent aesthetic satisfaction. Spontaneously resolving edge necrosis occurred in 13.9%. The mean ± SD time-to-start-ambulation was 1.7 weeks ±0.5. At the 2-year follow-up visit, all patients had reduced U-turn flap pivot point redundancy without shoe size impact, needing reoperation, or donor site morbidity. Edge necrosis was significantly associated with length-to-width ratio ( P = 0.014) but not with Foot and Ankle Outcome Score or Foot Function Index.
CONCLUSIONS: Metatarsal artery flap of U-turn design was reliable and was associated with a short recovery time, alternative resolution for forefoot area due to short operation time, minimal blood loss, short hospital length of stay, and excellent availability.