远端蒂腓肠神经筋膜皮瓣的临床演变与应用  

Clinical Evolution and Application of Distally Based Sural Neurofasciocutaneous Flap for Distal Lower Leg, Foot and Ankle Coverage

作　　者：张世民[1] 俞光荣[1] 袁锋[1] 周家钤[1] 张峰[1] 

机构地区：[1]同济大学附属同济医院骨科,上海200065

出　　处：《同济大学学报（医学版）》2005年第1期42-48,共7页Journal of Tongji University(Medical Science)

基　　金：中国博士后科学基金资助项目 (2 0 0 2 0 3 1176) ;上海市卫生局科研基金资助项目 (0 44 10 2 )

摘　　要：目的　总结远端蒂腓肠神经筋膜皮瓣修复小腿下 1/ 3和足踝创面的经验 ,探讨提高其成活质量的方法。方法　自 1994 - 2 0 0 4年共应用远端蒂腓肠神经营养血管皮瓣 2 3例 ,蒂部均包含腓肠神经、小隐静脉和深浅筋膜 ,宽度 3～ 5cm。旋转轴点为腓动脉外踝后上方 (5cm)的最远侧肌间隔穿支。皮瓣面积 17cm× 6cm～ 30cm× 10cm。皮瓣类型 :腓肠神经筋膜蒂岛状皮瓣 3例 ,水滴样岛状皮瓣 3例 ,带皮桥的岛状皮瓣 6例 ,筋膜皮下组织瓣翻转移位2例 ,穿支血管蒂岛状皮瓣 7例 ,穿支血管蒂岛状皮瓣携带长段腓肠神经 (2 7cm)修复胫神经缺损 1例 ,岛状皮瓣携带扩大的筋膜皮下瓣 1例 ,岛状皮瓣携带腓肠肌肉 1例。 13例将皮瓣中腓肠神经与受区皮神经吻合。在小隐静脉有充盈怒张的 15例皮瓣 ,于蒂部远端将小隐静脉结扎。结果　皮瓣转移后血液循环良好 ,但在创口渗血停止后 (术后 4 8小时 ) ,皮瓣多有肿胀 ,8例未在蒂部远端结扎小隐静脉者均出现张力水泡。结扎的 15例 ,皮瓣肿胀减轻 ,3例发生张力水泡。本组 2 3例皮瓣均完全成活。皮瓣供受区无重要并发症 ,5例有轻微并发症 (2 1.7% ) ,包括皮瓣伤口部分裂开 (2例 )、皮瓣表皮坏死脱落 (2例 )、供区植皮愈合不良 (1例 )等。 17例随访 6月～ 5年 ,供区无痛性神经瘤发生。Objective To introduce the clinical experience and evolution of distally based sural neurofasciocutaneous flap for distal lower leg,foot and ankle coverage,and discuss the technique to promote its survival quality.Methods From 1994 to 2004,23 cases of distally based sural fasciocutaneous flap with a 3-5 cm wide neuro-veno-adipofascial pedicle were used in clinic.The flap was supplied by the lowermost perforator of peroneal artery in the posterolateral septum.The pivot point was located at 5 cm above lateral malleolar tip.The flap size measured around 17 cm×6 cm～30 cm×10 cm.Flap types included island fasciocutaneous flap (3 cases),water-drop-like island fasciocutaneous flap (3 cases),island fasciocutaneous flap with a skin extension bridge (6 cases),turnover adipofascial flap (2 cases),perforator-based island fasciocutaenous flap (7 cases),perforator-based island flap carrying a 27 cm long sural nerve (1 cases),island fasciocutaneous flap with an adipofascial extension (1 cases),island gastrocnemius myofasciocutaneous flap (1).The sural nerve was anastomosed with the recipient nerve as sensate flap in 13 cases.The lesser saphenous vein was divided and ligated at 1cm distal to the pivot point in 15 cases.Results All flaps showed good circulation in the early stage after operation.When blood oozing coagulated 48 hour after surgery,all flaps demonstrated some venous congestion.In the 15 cases that the distal lesser saphenous vein was ligated,venous congestion was improved much better and only 3 had tension blisters.While 8 cases had not ligated,all suffered blisters.All 23 flaps survived eventually.No major complications encountered.Minor complications occurred in 5 cases (21.7%) including wound dehiesence (2 cases),epidermiolysis (2 cases),and partial donor site split-thickness skin graft lose (1 cases).There was no painful neuroma in 17 cases followed up for 6 months to 5 years.Static 2-PD was 12-20 mm in 12 sensate flaps followed up for 1-5 years.Conclusion Distally based neurofasciocutaneous island flap a

关 键 词：皮神经营养血管皮瓣 远端蒂皮瓣 筋膜皮瓣 腓肠神经筋膜皮瓣 足踝 腓肠神经 小隐静脉 

分 类 号：R616.2[医药卫生—外科学]