腓肠神经营养血管肌皮瓣的解剖与临床应用  

Anatomic study and clinical application of surai neuro- myocutaneous compound flap transposition

作　　者：陶圣祥[1] 喻爱喜[1] 余国荣[1] 邓凯[1] 郑晓晖[1] 张奕[1] 张建华[1] 

机构地区：[1]武汉大学中南医院显微骨科,武汉大学医学院显微外科研究所,430071

出　　处：《中华整形外科杂志》2008年第1期16-19,共4页Chinese Journal of Plastic Surgery

基　　金：湖北省科技攻关项目（2007AA301B37-1）

摘　　要：目的探讨腓肠神经营养血管肌皮瓣转移修复足踝部软组织缺损的解剖学依据及其临床应用效果。方法对30侧成人下肢灌注标本进行解剖，系统观测小腿后区浅层中血管神经的分支、分布及相互交通吻合情况。在此基础上，2004年2月以来应用逆行腓肠神经营养血管肌皮瓣修复足踝部软组织缺损7例。结果以腓肠神经、小隐静脉及股后皮神经的营养血管为主的浅筋膜血管网与深部的腓肠肌内外侧头有恒定的交通吻合，吻合支均为2-3支，腓肠肌内、外侧头肌皮穿支分别位于内外侧头肌间沟两侧（1．8±0．5）cm、（3．7±0．9）cm，内侧头的肌皮穿支较外侧粗大，位置恒定，更靠近中线。7例肌皮瓣的肌肉面术中可见渗血活跃，血供良好，皮瓣均成活，所有病例均经2～6个月以上随访，骨髓炎治愈，肌皮瓣外形满意。结论带部分腓肠肌内外侧头肌肉的逆行腓肠神经营养血管皮瓣可以良好成活，手术操作简便，系足踝部软组织缺损可以选择的供区。Objective To investigate the anatomical study and clinical applications of sural neuron-myocutaneous flap transposition for repairing the special patients with soft tissue defect in foot and ankle. Methods The branches, distributions and anastomoses of the vessels and nerves lie in superficial layer of the posterior crural region were observed on 30 sides of adult cadaver lower limb specimens perfused with red latex. Since February 2004, distally based sural neuron-myocutaneous flap was applied for repairing 7 cases of soft tissue defect in foot and ankle. Results The nutrient vessels of sural nerve, small saphenous vein and posterior femoral cutaneous nerve anastomosed permanently with the musculocutaneous perforators of medial and lateral head of gastrucnemius. There were 2 - 3 anastomoses found respectively. The musculocutaneous perforators pierced the two heads of gastrecnemius muscle （ 1.8 ± 0.5） cm medially and （3.7 ± 0.9） cm laterally away from the groove of the muscle. The medial anastomoses more closed to the middle groove and their diameters were found larger than the lateral ones. In operation, we routinely observed the compound flap for 15 to 20 minutes and found actively errhysis on the muscle, so the fine blood circulation in the flap was demonstrated. All flap survived after operation and the cases were followed up 2 to 6 months with cured osteomyelitis and satisfied flap outline. Collusions Distally based sural neuro-myocutaneous flap can live. The operative method is simple. The flap offers an excellent donor site for repairing the soft tissue defect in foot and ankle in special cases.

关 键 词：腓肠神经营养血管 解剖 临床应用 血管肌皮瓣 修复 

分 类 号：R686[医药卫生—骨科学]