小腿部穿支螺旋桨皮瓣的显微解剖和临床应用  

The microsurgical anatomy and clinical application of perforator pedicle propeller flap of lower leg

作　　者：沈立锋[1] 刘亦杨[1] 饶利兵 郭峭峰[1] 黄凯[1] 张展[1] 向长河 黄文华[3] 张春[1] 

机构地区：[1]浙江省立同德医院修复重建中心,杭州市310012 [2]湖南医药学院解剖系 [3]南方医科大学人体解剖学教研室

出　　处：《中华显微外科杂志》2016年第3期269-275,共7页Chinese Journal of Microsurgery

基　　金：浙江省公益技术研究项目（2014C33272）;浙江省院所专项基金项目（2014F50027）;浙江省公益技术研究项目（2015C33195）

摘　　要：目的观察腓动脉和胫后动脉穿支显微解剖特点，应用腓动脉或胫后动脉穿支蒂螺旋桨皮瓣修复小腿远端及足踝部软组织缺损创面，探讨其并发症防治措施。方法2011年3月至2011年4月，对5具新鲜尸体共10侧小腿标本，用红色乳胶灌注胭动脉、蓝色乳胶灌注静脉，解剖并观察统计腓动脉和胫后动脉穿支数量、长度、走行角度、血管直径和动静脉伴行情况等指标；从2011年6月至2013年6月，对47例小腿远端以及足踝部软组织缺损病例用穿支蒂螺旋桨皮瓣修复，观察临床疗效并统计并发症发生率，探讨并发症防治的方法。结果腓动脉和胫后动脉共发出穿支92支，其中有2条伴行静脉的有52支，有1条伴行静脉的有37支，伴行静脉缺如的1支，还有2支腓动脉穿支穿深筋膜后共用1条伴行静脉进入皮肤。腓侧在距外踝（3．0±1．0）cm和（8．0±2．O）cm处、胫侧在距内踝（5．0±1．0）cm和（8．0±1．0）cm处有较为恒定的穿支血管穿出深筋膜进入皮肤。36例腓动脉穿支蒂螺旋桨皮瓣其穿支穿出深筋膜距离外踝距离6—18cm，平均10．1cm。其中24例穿支位置在距外踝（8．0±2．0）cm范围内；11例胫后动脉穿支穿出深筋膜距离内踝6—18cm，平均9．5cm，其中有6例穿支位置在距内踝（8．0±1．0）cm范围内；并发症包括1例皮瓣下积血，1例感染，1例供区植皮坏死．13例静脉回流障碍，其中4例出现远端部分坏死。结论以腓动脉穿支和胫后动脉穿支为蒂的螺旋桨皮瓣外表美观，操作简单，是修复小腿远端及足踝部创面的首选方案之一；腓动脉在距外踝（8．0±2．0）cm范围内穿出深筋膜的穿支恒定，长度以及血管口径适合，是设计螺旋桨皮瓣血管蒂的最佳选择。Objective The research expects to investigate the gross anatomical characteristics of the perforating branches of posterior tibia] artery and peroneal artery and repair the soft tissue defect in distal termination of leg and around the foot and ankle by using the perforator pedicled propeller flap of the two arteries. The prevention measures for the complications were also explored. Methods From March, 2011 to April, 2011, concerning the specimens of 10 sides of 5 fresh cadavers, red latex was peffused into the popliteal arteries while blue latex was perfused into the veins. Then, after anatomization, the indexes, including the number, length, orientation angles, vessel diameter and the concomi- tant relationship between the artery and vein, of the perforating branches of posterior tibial artery and peroneal artery were recorded. From June, 2011 to June, 2013, 47 cases with soft tissue defect in distal termination of leg and around the foot and ankle were treated by repairing the perforator pedicled propeller flap. On this basis, the clinical effect was observed and the complication rate was calculated so as to study the prevention methods for the complications. Results The perforating branch occurred in 92 posterior tibia] and poronea] arteries. Among them, each of 52; arteries had 2 doncomi- tant veins, 37 presented 1 concomitant vein, and 1 had no eonoomitant vein; the perforating branches of 2 poronea] arter- ies entered into the skin by sharing 1 concomitant vein after perforating deep fascia. On fibular side, at （3.0± 1.0） cm and （8.0 ± 2.0） em from lateral malleolus, on tibia] side, at （5.0 ± 1.0） em and （8.0 ± 1.0） cm from medial：malleolus, Constant perforating vessels of peroneal artery went into the skin after perforating deep fascia. Concerning the. perforatgr pedicled propeller flaps of 36 peronea] arteries, the perforating branches were 6 to18 em and 10.1 cm on average to the lateral malleolus after perforating deep fascia. Among them, the perforating branch of 24 cases located

关 键 词：螺旋桨皮瓣 小腿 显微外科解剖 修复 并发症 静脉回流障碍 

分 类 号：R658.3[医药卫生—外科学]