远端蒂腓肠神经营养血管肌皮瓣的血供研究  

Blood supply of the distal pedicled sural nerve nutrient vessel myocutaneous flap

作　　者：葛军委[1] 黄东[2] 张惠茹[2] 吴伟炽[2] 江钦文[1] 黄国英[2] 

机构地区：[1]广东医学院研究生学院,广东湛江524000 [2]广东省第二人民医院创伤外科,广州510317

出　　处：《中国临床解剖学杂志》2011年第2期149-151,154,共4页Chinese Journal of Clinical Anatomy

基　　金：广东省医学科研基金(A2010135)

摘　　要：目的研究腓肠神经营养血管链与肌皮瓣血供之间的关系。方法 17例新鲜成人小腿标本,16例灌注红色乳胶,1例灌注明胶氧化铅。解剖观测小腿后区各层中血管的解剖特点,重点观察腓肠神经营养血管链与肌皮动脉穿支之间的交通吻合。结果 （1）外踝尖上10 cm内,后外侧肌间隔内腓动脉发出0~3支穿支,外踝后间隙内腓动脉终末支及其延续的跟外侧动脉,共发出2~3条皮肤穿支;（2）腓肠神经营养血管链在深筋膜下与两侧的腓肠肌肌皮动脉穿支间有2~7个吻合支,在深筋膜上与两侧的腓肠肌肌皮动脉穿支间各有2~3个吻合支。在腓肠肌的腱腹交界近侧2~4 cm内,与1~3支肌皮动脉穿支血管恒定交通吻合。结论 （1）腓肠神经营养血管轴与腓肠肌内、外侧头肌皮动脉穿支之间有恒定的交通吻合,是远端蒂腓肠神营养血管肌皮瓣血供的基础;（2）在没有较粗的血管穿支的个体可将蒂部相邻的两个穿支包含在蒂内。Objective To explore anatomic features of nutrient vessels of sural nerve and its possibility to supply the myocutaneous flap.Methods 17 fresh adult leg specimens were used in this study,with 16 cases perfused with red emulsion,and 1 case with gelatin and lead oxide.The posterior regions of the leg were dissected layer by layer,for investigating the distribution and anastomosis of perforator arteries of myocutaneous arteries with nutrient vessels of sural nerve.Results Fibular artery gave off 0 to 3 perforators in the posterolateral muscle interval above the tip of lateral malleolus about 10cm.Terminal branches and lateral calcaneal arteries of this artery in the posterior interval of lateral malleolus continued to send out 2 to 3 skin perforators.2 to 7 anastomostic branches could be found between nutrient vessels of sural nerve and bilateral myocutaneous perforators of gastrocnemius,which was in the deep fascia.Another 2 to 3 ramus anastomoticus appeared between bilateral myocutaneous perforators,as well,1 to 3 perforators existed persistantly and anastomosed with each other near the connection of muscle and tendon of gastrocnemius with the range of 2~4 cm.Conclusions Permanent anastomosis among myocutaneous perforators of medial and lateral heads of gastrocnemius and nutrient vessels of sural nerve can be found,which is the anatomic basis for designing blood supply of the distal pedicled sural nerve nutrient vessel myocutaneous flap.Closed perforators can be taken as pedicle vessels to repair defects of the individual without suitable perforators.

关 键 词：腓肠神经 皮神经营养血管皮瓣 远端蒂 肌皮瓣 血供 应用解剖 

分 类 号：R323.72[医药卫生—人体解剖和组织胚胎学] R616.2[医药卫生—基础医学]