胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣的临床解剖与应用

摘要

目的 研究胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣移位修复足踝创面的临床解剖与应用.方法 选取红色乳胶动脉灌注的2侧新鲜和8侧4％甲醛固定下肢标本于手术显微镜下进行解剖研究,观察胫后动脉、腓肠外侧皮动脉及腓肠外侧皮神经的解剖学特征.根据解剖学结果设计皮瓣.纳入2007年2月至2012年6月行胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣修复的患者15例,观察疗效.结果 设计以胫后动脉在小腿远端穿支为蒂的胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣,胫后动脉穿支由腓肠外侧皮神经-腓肠神经营养血管链、穿支与腓肠外侧皮动脉间吻合血管两条供血通路逆行灌注.15例患者中移植皮瓣全部成活13例;9例静脉回流良好,移植皮瓣完全成活,6例术后出现静脉危象,其中2例移植皮瓣远端部分坏死.随访12例,随访34～ 98个月,皮瓣质地及外观良好,术后6个月皮瓣两点辨别觉(12 ±4) mm;踝关节功能优5例、良5例、中3例、差2例.结论 胫后动脉穿支-腓肠外侧皮神经营养血管皮瓣血供充分且受解剖变异影响小,可用于踝周和足底内侧负重区皮肤缺损的修复.%Objective To study the anatomical basis of distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator and its clinical application in foot ankle wound repair.Methods Eight sides of 4％ formaldehyde-fixed and 2 sides of fresh cadavers were infused with colored red latex and dissected under operating microscope.The posterior tibial artery,lateral sural cutaneous artery,lateral sural cutaneous nerve were observed.Based on the results of anatomic study,the flaps were designed for clinical reparative application.From February 2007 to June 2012,15 patients underwent reparative operation of in foot ankle wound with distally based lateral sural cutaneous nerve nutrient vessels island flap and the effects were observed.Results The distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator was designed,which were retroperfused by nutrient vessel of lateral sural cutaneous nerve-sural nerve and anastomosis between branch of posterior tibial artery perforator and lateral sural cutaneous artery.Among 15 cases,13 flaps showed complete survival;9 flaps showed good venous return,6 flaps showed venous crisis with marginal flap necrosis occurred in 2 patients.Totally 12 patients received follow-up of 34 to 98 months;their flaps appearance and function were satisfactory;6 months after surgery,the two points discrimination of flap was (12 ± 4) mm.Five cases had excellent,5 cases had good,3 cases had fair and 2 cases had poor ankle founction.Conclusion The distally based lateral sural cutaneous nerve nutrient vessels island flap pedicled by posterior tibial artery perforator is well supplied,with less anatomic variants,which can be safely designed and used in repairing defects of peri-ankle area and weight bearing area of foot.