腓动脉前、后终末穿支的解剖与临床应用  

Anatomy and clinical application of anterior and posterior terminal perforators of peroneal artery

作　　者：杨涛[1] 韩兆峰[1] 周明武 李士民 宋健 胡智玉 张广超 YANG Tao;HAN Zhaofeng;ZHOU Mingwu;LI Shimin;SONG Jian;HU Zhiyu;ZHANG Guangchao(Department of Plastic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou Henan,450052,P.R.China;Department of Trauma Microsurgery,No.988 Hospital of Joint Logistic Support Force,Zhengzhou Henan,450042,P.R.China)

机构地区：[1]郑州大学第一附属医院整形外科,郑州450052 [2]解放军联勤保障部队第988医院创伤显微外科,郑州450042

出　　处：《中国修复重建外科杂志》2019年第9期1156-1161,共6页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨腓动脉前、后终末穿支的解剖与临床应用。方法自3具新鲜尸体腘窝处离断截取双侧小腿标本共6侧,显微解剖暴露腓动脉前、后终末穿支及腓动脉终末支穿支血管,观察并测量各穿支起始处与外踝尖距离及其外径。2016年10月—2018年12月,结合解剖测量结果以及超声造影增强技术(contrastenhanced ultrasound,CEUS),选择以上述穿支为蒂的外踝区穿支皮瓣修复18例足踝部皮肤缺损患者。其中男14例,女4例;年龄28~62岁,平均40岁。创面范围4 cm×3 cm^13 cm×10 cm。采用腓动脉前终末穿支皮瓣13例,腓动脉后终末穿支皮瓣5例;皮瓣切取范围5 cm×4 cm^14 cm×10 cm。供区7例直接缝合,11例全厚皮片植皮修复。结果腓动脉前终末穿支起始处与外踝尖距离为(5.1±0.5)cm,外径为(1.51±0.05)mm;腓动脉后终末穿支分别为(4.9±0.9)cm、(1.78±0.17)mm,腓动脉终末支穿支分别为(1.7±0.7)cm、(0.58±0.12)mm。临床应用结果显示,术后2例皮瓣边缘发暗,经换药后瘢痕愈合;1例因切口感染再次扩创后愈合;其余皮瓣均成活良好,切口Ⅰ期愈合。3例患者因皮瓣臃肿于术后3个月行整形术。患者均获随访,随访时间3~18个月。皮瓣质地、外观良好,感觉部分恢复。末次随访时,采用美国矫形足踝协会(AOFAS)评分评价,获优9例、良6例、中2例、差1例,优良率83.3%。结论对腓动脉外踝区穿支血管进一步细化有助于临床理解以及合理选择及应用外踝区穿支皮瓣。Objective To investigate the anatomy of anterior and posterior terminal perforators of the peroneal artery and its clinical applications. Methods Six lower limb specimens were obtained from 3 fresh cadavers. The anterior and posterior terminal perforators and the perforator of terminal peroneal artery were exposed under surgical microscope,and the distances from the beginning of each perforator branch to the lateral malleolus tip and the external diameter of each perforator were measured. With these anatomical knowledge and contrast-enhanced ultrasound(CEUS) guidance,the pedicle flaps with above-mentioned perforators were rationally selected and precisely designed for 18 patients with skin defects in the ankle and foot region between October 2016 and December 2018. Among the patients, there were 14 males and 4 females, aged 28-62 years, with an average age of 40 years. The area of wound ranged from 4 cm×3 cm to13 cm×10 cm and the area of skin flap ranged from 5 cm×4 cm to 14 cm×10 cm. The anterior peroneal artery terminal perforator flap were applied in 13 cases and the posterior peroneal artery terminal perforator flap in 5 cases. The donor sites were closed directly in 7 cases and repaired with full thickness skin graft in 11 cases. Results The distance from the beginning of the anterior terminal perforator to the lateral malleolus tip was(5.1±0.5) cm, the external diameter of the anterior terminal perforator was(1.51±0.05) mm. The distance from the beginning of the posterior terminal perforator to the lateral malleolus tip was(4.9±0.9) cm, the external diameter was(1.78±0.17) mm;the distance from the beginning of the perforator of terminal peroneal artery to the lateral malleolus tip was(1.7±0.7) cm, the external diameter was (0.58±0.12) mm. Clinical application results: The edge of the flap was dark in 2 cases after operation and healed after surgical dressing, and 1 case of wound infection healed gradually after debridement. The other flaps survived and healed by first intention. Three patients und

关 键 词：腓动脉穿支皮瓣 终末穿支 超声造影增强技术 外踝区 

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