后踝上皮瓣血供的解剖观察及临床应用  

Anatomical study and clinical applications of posterior supramalleolar flap

作　　者：高秋明[1] 张宇[1] 薛云[1] 厉孟[1] 邓银栓[1] 时培晟[1] 

机构地区：[1]兰州军区兰州总医院全军创伤骨科中心,兰州730050

出　　处：《中华解剖与临床杂志》2016年第2期124-128,共5页Chinese Journal of Anatomy and Clinics

摘　　要：目的：探讨后踝上皮瓣的解剖特点,总结后踝上皮瓣治疗足踝部软组织缺损的临床经验,为后踝上皮瓣的临床应用提供依据。方法2012年8—10月收集8侧新鲜成人下肢标本,股动脉灌注红色乳胶,解剖观察胫后动脉在小腿下段内侧的皮穿支及其营养腓肠神经、腓肠外侧皮神经的情况；观察腘窝外侧皮动脉穿出部位、走行、分布及与胫后动脉踝上穿支吻合情况,测量腘窝外侧皮动脉长度及直径。回顾性分析2007年2月—2012年6月兰州军区兰州总医院全军创伤骨科中心采用后踝上皮瓣移植修复的15例足踝部软组织缺损患者的临床资料,其中男11例,女4例；年龄18~49岁,平均33岁；创面位于小腿下1/3段3例,足踝部7例,足底负重区5例。15例患者均采用后踝上皮瓣移植修复；术后观察患者皮瓣成活情况,创面完全愈合后1个月,有骨折者骨折临床愈合后3个月采用美国矫形足踝协会（AOFAS）评分系统评定踝关节功能。结果8侧下肢标本观察示,胫后动脉在小腿下段发出2~4支肌间隙皮动脉,均有分支向外上方走行,供应腓肠神经及腓肠外侧皮神经,并与腘窝外侧皮动脉间有确定的吻合支；均见腘窝外侧皮动脉,起于股骨内外髁连线上方（1.8±0.47）cm 处,于腘窝后正中线外侧（1.1±0.14）cm 处穿出深筋膜并沿腓肠肌外侧头表面下行；腘窝外侧皮动脉均与腓肠外侧皮神经伴行,腘窝外侧皮动脉全长（14.21±3.89） cm、直径（1.23±0.24）mm。临床应用后踝上皮瓣移植修复足踝部软组织缺损15例,移植皮瓣全部成活13例,2例远端部分坏死。12例患者获随访6~18个月,平均11个月。患者皮瓣质地及外观良好,术后踝关节功能优8例,良4例。结论后踝上皮瓣血管蒂位置相对隐蔽,外伤后不易损伤,且修复范围大,成活率高,是治疗足踝部软组织大面积缺损的一种较好的选择。Objective To probe the anatomical characteristics of posterior supramalleolar flap and summarize the clinical experience of application of posterior supramalleolar flaps to repair serious foot and ankle trauma complicated by soft tissue defects, and to provide the basis for the clinical application of posterior supramalleolar flaps. Methods From August 2012 to October 2012 in 8 lower limb specimens of adult human cadavers, the cutaneous branches of the posterior tibial artery in 1 / 3 lower segment of cnemis marked by means of red latex through femur artery and their blood nutrition to the sural nerve and the lateral sural nerve were observed anatomically. The location, course, distribution of the lateral popliteal cutaneous artery and the anastomosis with the supramalleolar cutaneous branches of the posterior tibial artery were also observed anatomically. The length and outer diameter of the lateral popliteal cutaneous artery were measured. From February 2007 to June 2012, the clinical data of 15 cases treated by posterior supramalleolar flaps in the Center of Orthopedic Surgery, General Hospital of Lanzhou Military Region were retrospectively analyzed. There were 11 males and 4 females, aged 18 - 49 years （mean, 33 years）. The trauma locations were 1 / 3 lower segment of cnemis in 3 cases, ankle and foot in 7 cases, weight loading plantar region in 5 cases. All soft tissue defects of patients were repaired by posterior supramalleolar flap. The survival of the flaps were observed after operations. 1 month after the wounds healed completely or 3 months after the fractures healed clinically the postoperative function was evaluated according to the American Orthopedic Foot and Ankle Society（ AOFAS） score. Results In 8 lower limb specimens, the posterior tibial artery gave off 2 to 4 septocutaneous branches at 1 / 3 lower segment of cnemis. The septocutaneous branches toward the proximal and lateral supplied blood nutrition to the sural nerve and the lateral sural nerve, and anastomosed definitely with the l

关 键 词：外科皮瓣 后踝上皮瓣 软组织损伤 踝 

分 类 号：R658.3[医药卫生—外科学] R322[医药卫生—临床医学]