远端蒂腓肠神经营养血管皮瓣的解剖及临床应用

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摘要目的探讨远端蒂腓肠神经营养血管皮瓣旋转点下移的解剖学基础及临床应用效果。方法 5例膝上截肢标本经股动脉灌注乳胶硫酸钡溶液，解剖观察小腿后外侧肌间隔附近筋膜皮肤穿支的起源、分布、数量、外径，然后对剥离的体表组织行X线检查。自2013年1月至2018年9月，临床应用远端蒂腓肠神经营养血管皮瓣修复足踝部及前足、中足软组织缺损22例，其中男性20例，女性2例，年龄3~70岁，平均43岁。皮瓣大小6 cm×5 cm~14 cm×11 cm，旋转点位于外踝上2~5 cm，修复受区创面大小为5 cm×4 cm～13 cm×10cm。结果跟外侧动脉于外踝上平均2.1 cm、4.0 cm发出2支皮肤穿支，穿入深筋膜处血管外径为0.5~0.8 mm；22例皮瓣中14例完全存活，8例远端边缘部分坏死，坏死面积约1 cm×1 cm~1 cm×3 cm，经换药后痊愈。结论该皮瓣血运可靠，设计灵活，手术切取简便，适合修复足踝部及小腿下段皮肤软组织缺损创面，值得临床推广。

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关键词 ：外科皮瓣, 腓动脉穿支, 移植, 应用解剖

Abstract：Objective To explore the anatomical basis and clinical application of distal sural neurovascular flap with downward shift of rotation point.Methods Five cases of superior knee amputation were perfused with latex barium sulfate solution through the thigh artery.The origin，distribution，quantity and outer diameter of the perforating branch of the fascia near the posterolateral muscle septum of the leg were dissected and examined by X-ray.From January 2013 to September 2018，22 cases of distal sural neurovascular flap were used，they were 20 males and 2 females，and they aged 3 to 70 years with an average age of 43 years.The size of the flap was 6 cm×5 cm～14 cm×11 cm，the rotation point was 2~5 cm above the lateral malleolus，and the wound size in the recipient area was 5 cm×4 cm~13 cm×10 cm.Results The lateral calcaneal artery was 2.1 cm and 4.0 cm on the lateral malleolus，and 2 skin branches were sent out at，and the external diameter of the vessels penetrated into the deep fascia was 0.5~0.8 mm.In this group，14 cases were completely alive，8 cases were partial necrosis，and the necrotic area was about 1 cm×1 cm～1 cm×3 cm，which was cured after dressin.Conclusion The flap blood supplyis reliable，flexible to design，safe in surgical heavest and suitable for repair leg and skin and soft tissue of the foot and ankle wounds.It is worthy of clinical promotion.

Key words： surgical flaps perforating branch of peroneal artery transplant applied anatomy

基金资助:湖南省自然科学基金株洲联合项目(2017JJ4073)

通讯作者: 张锡平

作者简介: 徐强(1982－ )，男，主治医师，中南大学湘雅医学院附属株洲医院(株洲市中心医院)骨科，412007。

引用本文:

徐强 1，张锡平 1*，王镖 1，杨新佑 1，邱尔钺 1，董忠根 2. 远端蒂腓肠神经营养血管皮瓣的解剖及临床应用[J]. 实用骨科杂志, 2020, 26(3): 228-231.
Xu Qiang，Zhang Xiping，Wang Biao，et al. Anatomy and Clinical Application of Distal Sural Neurovascular Flap. sygkzz, 2020, 26(3): 228-231.

链接本文:

http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2020/V26/I3/228

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