游离腓肠内侧动脉穿支皮瓣修复手足皮肤软组织缺损  

Reconstruction of the skin and soft defects of hand and foot by free medial sural artery perforator flap

作　　者：潘佳栋[1] 王欣[1] 梅劲[2] 陈宏[1] 范学锴[1] 王胜伟[1] 胡浩良[1] 章伟文[1] 

机构地区：[1]宁波市第六医院手外科,浙江省宁波市315040 [2]温州医学院人体解剖学教研室

出　　处：《中华显微外科杂志》2012年第2期93-96,I0004,共5页Chinese Journal of Microsurgery

基　　金：基金项目：国家自然科学基金项目（30871308）;宁波市自然科学基金项目（2011A610046）

摘　　要：目的探讨以腓肠内侧动脉穿支血管为蒂的穿支皮瓣游离移植修复手足深部组织外露创面的临床疗效。方法对两具新鲜尸体行全身动脉造影．并对小腿部动脉进行二维显影和三维重建。2007年4月至2010年12月，我科应用腓肠内侧动脉穿支皮瓣游离移植修复手、足部皮肤缺损34例。其中，手部25例，足部9例；感染创面12例，清洁创面22例，皮肤缺损面积6cm×4cm～13cm×8cm，皮瓣切取面积为7cm×5cm～14cm×9cm.23例皮瓣由1条穿支血管营养，余11例由2条穿支营养；15例在切取皮瓣时解剖出1条浅静脉与受区浅静脉吻合，9例皮瓣通过缝合皮神经重建感觉。结果将小腿后区分为5个血管区，并获得腓肠动脉及其分支的三维重建图像。临床应用29例皮瓣均顺利成活，5例皮瓣出现水泡，经拆线处理最终成活。随访6～21个月，皮瓣色泽与受区相似，无明显臃肿，9例缝合皮神经的手背部皮瓣感觉恢复为s2～s3。结论腓肠内侧动脉穿支皮瓣的血管解剖较恒定，皮瓣薄且柔软，不损伤小腿主要血管及腓肠肌，是手、足创面修复的良好选择。Objective To evaluate the curative effect of reconstruction of the hand and foot defects with bones and tendons exposure using free medial sural artery perforator flap （MSAP）. Methods Radiographs of 2 cadavers injected with a modified lead oxide-gelatin mixture were digitally analyzed. Between April 2007 and December 2010, thirty-four patients with soft tissue defects in the distal limb were treated with the free MSAP flap transplantation. The sizes of the defect ranged 6 cm × 4 cm-13 cm × 8 cm, and the flaps ranged 7 cm × 5 cm-14 cm × 9 cm. These clinical cases included 25 hands and 9 feet, all of them with bones and tendons exposure. In these defects, twenty-two were clean, twelve got infections. In our cases, twenty-three flaps were nourished with single perforator vessel and else 11 with two;perforator vessel fifteen flaps were dissected one superficial vein to anastomose with that of the recipient sites in addition to accompanying vein anastomosis; The sensation of 9 flaps recovered the hands were reconstructed with cuta- neous nerve anastomosis. Results A partition of the calf skin blood vessels, and three-dimensional reconstruction image of the sural artery were obtained. All flaps survived, five of them appeared partially violet and bubbles. Followed up 6-21 months, the cosmetic results were satisfactory and without apparent bulkiness. The flap colors were similar to recipient sites. The flap senses reconstructed with neural anastomosis recover to s2-s3. Condusion The new flap is very suitable to repair the soft tissue defect in the distal limbs, because the fairly constant perforator vessel, the reliable blood supply and the cosmetic shape of the MSAP flap are all advantages of it in addition to no damage to low leg chief artery and gastrocnemius.

关 键 词：腓肠内侧动脉穿支皮瓣 手 足 数字化解剖 显微外科 

分 类 号：R658.3[医药卫生—外科学]