小腿内侧链型筋膜皮瓣的应用研究  

Research on the medial chain-type fasical flap application

作　　者：王凌峰[1] 王宏[1] 史二栓[2] 巴特[1] 张军[1] 刘和平[2] 侯智慧[1] 胡国林[1] 荣志东[1] 曹胜军[1] 孙一凡[1] 

机构地区：[1]内蒙古烧伤研究所,内蒙古医学院第三附属医院烧伤科,内蒙古包头014010 [2]包头医学院解剖教研室

出　　处：《中华损伤与修复杂志（电子版）》2008年第1期31-34,共4页Chinese Journal of Injury Repair and Wound Healing(Electronic Edition)

基　　金：包头医药卫生基金资助项目(No.2002-67)

摘　　要：目的探讨小腿内侧链型筋膜皮瓣修复足部软组织缺损的效果。方法成人尸体23具（46侧下肢），股动脉红色乳胶灌注，肉眼解剖观察小腿内侧链型筋膜皮瓣范围内动脉及其吻合支的分布及关系。在解剖学研究的基础上，于1995年1月至2006年12月间，应用小腿内侧链型筋膜皮瓣移植修复足部组织缺损16例。皮瓣最大面积为16cm×42cm，最小为8cm×12cm。其中皮瓣远端超过小腿中下1／3段的小腿内侧链型筋膜皮瓣4例。修复皮肤缺损范围最大面积为15cm×30cm，最小为5cm×8cm，术中将隐神经与受区神经吻合或在皮瓣断蒂时将隐神经与受区神经吻合。术后对皮瓣范围超过小腿中下1／3段的小腿内侧链型筋膜皮瓣常规使用皮瓣助活仪，19-28d断蒂。结果小腿内侧链型筋膜皮瓣范围内主要以皮下筋膜血管和肌间隙血管供血，多个节段性筋膜皮支相互间存在吻合接力，形成在浅、深筋膜的“纵行血管桥接”。移植皮瓣全部成活，无花斑，皮瓣皮肤感觉断蒂2-4周有痛温触觉，但不灵敏，或有感觉过敏现象。16-24周痛温触觉逐渐灵敏，感觉接近或恢复正常，感觉过敏消失。随访6-12月患者能正常行走，未发生破溃，外观及功能满意。结论小腿内侧链型筋膜皮瓣修复下肢巨大组织缺损安全可靠，效果好。皮瓣范围超过小腿中下1／3段的小腿内侧链型筋膜皮瓣需使用皮瓣助活仪保障皮瓣远端血运。Objective To explore the medial chain-type fasical flap transplantation for the repair of soft tissue defects in foot. Methods Twent three adult cadavers（46 sides lower limbs） were infused by latex in femoral artery, to observe the distribution and relationship between anastomosis branches in the medial chain-type fasical flap. On the basis of the anatomical study, from January 1995 to December 2006, the medial fasical flap was applied in the repair of skin defects of 16 cases, the area of flap ranged from 16 cm×42 cm to 8 cm × 12 cm. Among them, there were 4 cases over the one-third middle-lower leg on distal part of fasical flap. The repaired skin defects were ranging from 15 cm ×30 cm to 5 cm × 8 cm. The saphenous nerve and the recipient motor nerve were anastomosed during operation or pedicle division. After operation, Inter-mittent positive pressure instrument was routinely used in the flap. The pedicles of skin flap were divided at 19-28 days. Results The medial chain-type fasical flap was blood supplied by subcutaneous fascio-vascular and cutaneous branch of posterior tibial artery. There was a constant anastomosis among multiple segmental cutaneous branches, forming “longitudinal vascular bridging” between superficial and deep fascia. The skin flap by transplanting all survived, no flap necrosis. There were pain and temperature sensation after the pedical was divided for 2-4 weeks, but insensitive or hypersensitive. After 16-24 weeks, the sense of pain and temperature became more and more sensitive. Sensory became normal or near mormal, and hypersensitivity disappeared. After 6-12 months postoperative follow-up, the appearance and functional restoration was satis- factory. The patients can normally removed. Conclusions It is reliable for repairing lower limbs tissue defects by the medial chain-type fascial flap. with a good effect. It needs using intermittent positive pressure instrument over the one-third middle-lower leg on distal part of fascial flap, which ensures blood circulation of the

关 键 词：小腿内侧皮瓣 软组织缺损 修复 间歇式正压 

分 类 号：R658.3[医药卫生—外科学]