逆行缝接神经法重建腓肠皮瓣感觉功能的临床应用  

Report on clinical application of retrograde neurorrhaphy for reconstruction of sensory function of sural flap

作　　者：余晓军 陈雪松 徐永清 王晓凤 张世民[3] YU Xiaojun;CHEN Xuesong;XU Yongqing;WANG Xiaofeng;ZHANG Shimin(Deparment of Trauma and Microsurgery,No.926 Hospital of Combined Service Force of the Chinese People's Liberation Army,Kaiyuan,Yunnan Province 661600,China;Deparment of Orthopaedics,No.920 Hospital of Combined Service Force of the Chinese People's Liberation Army,Kunming 650000,China;Deparment of Orthopaedics,Affiliated Yangpu District Central Hospital of Tongji University,Shanghai 200082,China)

机构地区：[1]中国人民解放军联勤保障部队第九二六医院创伤显微外科,云南开远661600 [2]中国人民解放军联勤保障部队第九二〇医院骨科,昆明650000 [3]同济大学附属杨浦区中心医院骨科,上海200082

出　　处：《中华显微外科杂志》2020年第3期248-253,共6页Chinese Journal of Microsurgery

基　　金：云南省创伤骨科临床医学中心(建设单位)(ZX20191001);云南省钟世镇院士工作站(2015IC030);云南省省院省校合作基金(2018JS094)。

摘　　要：目的探讨一种重建腓肠皮瓣感觉功能的新方法的疗效,并分享经验。方法2018年5月至2019年11月,应用腓肠皮瓣修复手、足创面12例。12例24侧小腿,术前均行血管CDFI检查,穿支部位距外踝尖6.8~20.5 cm,均值为12.5 cm;根部内径1.0~1.8 mm,均值为1.35 mm;术前血管根部血流速度为28.7~51.6 m/s,平均38.8 m/s。为重建皮瓣感觉,8例逆行设计的游离腓肠皮瓣,将穿支远侧的腓肠神经或腓肠内、外侧皮神经与受区皮神经进行缝接;2例螺旋桨腓肠皮瓣,将小桨侧的腓肠神经断端与皮瓣供区近侧缘皮神经进行直接缝接或桥接;2例远端筋膜蒂腓肠皮瓣,行外踝以远纵行切口,分离腓肠神经及伴行血管,远端切断旋转后与受区腓浅神经或足背中间皮神经进行缝接。将这种通过缝接皮瓣原远侧皮神经重建感觉功能的方法定义为逆行缝接神经法。结果所有病例获得门诊随访,时间6个月~1.5年,检测皮瓣感觉功能恢复时,均排除了通过创基神经长入恢复皮瓣感觉的部分。根据1954年英国医学研究会制定的感觉功能评定标准,感觉恢复S41例,S3+8例,S32例,S21例。结论逆行缝接神经法重建腓肠皮瓣感觉功能疗效确切,并可显著增加该类皮瓣感觉功能重建机会。Objective To report the effect of a new method to reconstruct the sensory function of sural flap and to share the experience.Methods From May,2018 to November,2019,12 patients with hand and foot injuries were treated with sural flap.Blood vessel CDFI examination was performed on 24 shanks of 12 patients before operation.The perforator site was 6.8-20.5 cm from the lateral malleolus apex,with an average of 12.5 cm.The inner diameter of the root was 1.0-1.8 mm,with an average of 1.35 mm.Before operation,the velocity of blood flow velocity at the vascular root was 28.7-51.6 m/s,with an average of 38.8 m/s.In order to reconstruct the sensation of flap,in the design of free sural skin flaps of 8 patients,the distal sural nerve or medial and lateral sural cutaneous nerve of the perforating branch was anastomosed with the cutaneous nerve of the recipient region.In 2 cases of propeller sural flap,the severed end of sural nerve on the small propeller side was directly anastomosed or bridged with the cutaneous nerve on at the proximal edge of the skin flap donor site.In 2 cases of distal fascial-pedicled sural flap,the lateral malleolus was cut in a distal longitudinal shape to separate the sural nerve and accompanying blood vessels.After distal cutting and rotation,the sural flap was anastomosed with the superficial peroneal nerve in the recipient site or the medial cutaneous nerve of the dorsum of the dorsal foot.This method of reconstructing sensory function by anastomosing the original distal cutaneous nerve of the flap was defined as retrograde neurorrhaphy.Results All patients were followed-up for 6 months to 1.5 years.The mechanism recovery of the peripheral pathway was excluded in the sensory function examination of flap.According to the evaluation standard for sensory function established by the British Medical Research Council in 1954,sensory recovery was as follows:1 case for S4;8 cases for S3+;2 cases for S3;and 1 case for S2.Conclusion Retrograde neurorrhaphy has definite therapeutic effects in reconstructing

关 键 词：腓肠皮瓣 感觉功能重建 逆行缝接神经法 疗效 

分 类 号：R622.1[医药卫生—整形外科]