远端蒂腓肠神经筋膜肌皮瓣的血管解剖与临床应用  

Distally based sural neuro-fascio-myocutaneous flap: vascular basis and clinical applications

作　　者：张世民[1] 张凯[2] 李海丰[1] 袁锋[1] 俞光荣[1] 

机构地区：[1]同济大学附属同济医院骨科 [2]同济大学医学院解剖学教研室,上海200065

出　　处：《中国临床解剖学杂志》2005年第4期352-356,共5页Chinese Journal of Clinical Anatomy

基　　金：上海市卫生局科研基金(044102)

摘　　要：目的:介绍远端蒂腓肠神经筋膜肌皮瓣的血管解剖学基础与临床应用经验。方法:解剖6个小腿灌注标本,重点观察腓肠神经血管轴与腓肠肌内外侧头肌支和肌皮穿支之间的交通吻合。结果:在腓肠神经穿出深筋膜前(筋膜下段),腓肠神经血管轴与两侧的腓肠肌肌支间各有2～4个吻合。在穿出深筋膜后(筋膜上段),与两侧的腓肠肌肌皮穿支间各有2～3个吻合。在腓肠肌腱腹交界(约为小腿中点)的近侧2～4cm内,恒定有1～3支肌皮穿支血管与腓肠神经血管轴相交通。据此,临床上设计切取以腓动脉最远侧肌间隔穿支血管供血的腓肠神经筋膜蒂腓肠肌皮瓣,修复3例伴有死腔和骨髓炎感染的小腿下1/3段和足踝创面,筋膜皮瓣面积10～12cm×5～6cm,其深层的肌肉6～8cm×4～6cm,皮瓣完全成活。结论:远端蒂腓肠神经筋膜肌皮瓣,血供可靠,转移方便,是修复小腿下段和足踝部伴有死腔或骨髓炎创面的好方法。Objective: To introduce the anatomical study and clinical applications of distally based sural neurofascio-myocutaneous flap for distal lower leg and foot and ankle coverage. Methods: Six injected lower legs were dissected. The vascular anastomosis between the sural neurovascular axis and the muscle and musculocutaneous branches were identified. Then distally based sural neuroadipofascial pedicled gastrocnemius myocutaneous flap were raised clinically in 3 cases. Results: Before piercing the deep fascia, the sural neurovascular axis ran in the groove between the two heads of gastrocnemius muscle. There were 2~4 anastomoses between the sural axis and the bilateral muscle branches respectively. After piercing the deep fascia, the sural axis had 2~3 anastomoses with the musculocutaneous perforators of the medial and lateral gastrocnemius, respectively. Furthermore, in 2~4 cm proximal to the junction of tendon-muscle belly, there were usually 1~3 communicating branches connecting the sural axis and the gastrocnemius muscle. Based on these anatomic studies, distally based neurofasciomyocutaneous flap were successfully transferred in 3 cases, for reconstruction of the distal lower leg (1 case) and foot and ankle (2 cases) wounds complicated with large dead space (1 case) and osteomyelitis (2 cases). The fasciocutaneous flaps measured 10～12cm×5～6cm, with deep attached gastrocnemius muscle 6～8 cm×4～6 cm. Conclusions: Distally based sural neurofascio- myocutaneous flap is a reliable, versatile and simple method for foot and ankle coverage, especially for complicated wounds such as dead space and osteomyelitis.

关 键 词：腓肠神经血管轴 腓肠肌 肌皮瓣 皮神经黄养血管皮瓣 筋膜皮瓣 外科皮瓣 

分 类 号：R616.2[医药卫生—外科学] R323.72[医药卫生—临床医学]