掌指动脉指蹼穿支蒂手背皮神经营养血管逆行皮瓣的应用

目的报道应用改进手术方法的手背皮神经营养血管逆行皮瓣修复手部皮肤组织缺损的临床效果。方法根据皮肤缺损部位应用以不同指掌侧动脉指蹼穿支为蒂的手背皮神经营养血管逆行皮瓣转位修复手及手指皮肤软组织缺损创面。皮瓣面积为2.5×1.5 cm~6.0 cm×3.5 cm。结果临床应用15例,皮瓣全部成活。术后随访6~24个月,皮瓣质地优良,外形与功能恢复满意。结论掌指动脉指蹼穿支蒂手背皮神经营养皮瓣手术切取方便,转位灵活,血供可靠,是修复手及手指皮瓣缺损的理想皮瓣。     

皮神经营养血管逆行皮瓣修复手部软组织缺损

目的 探讨以指动脉或尺动脉远端皮穿支为蒂的皮神经营养血管逆行皮瓣,修复手部软组织缺损的手术方法 和临床疗效.方法 根据缺损部位的不同,分别对32例手部皮肤软组织缺损进行修复,其中采用指动脉背侧穿支蒂指神经背侧支逆行皮瓣5例,拇指动脉背侧穿支蒂的拇尺背侧皮神经营养血管逆行皮瓣15例,指动脉指蹼穿支蒂的手背皮神经营养血管逆行皮瓣7例,尺动脉腕上皮穿支蒂的前臂内侧皮神经营养血管逆行皮瓣修复5例.皮瓣切取面积为1.9 cm×2.0 cm～7.0 cm×10.0 cm.在修复指腹软组织缺损的患者中,将皮瓣中的皮神经与受区掌侧指神经缝合12例.结果 除1例皮瓣远端部分静脉回流障碍外,其余皮瓣均存活.术后随访时间为3个月～4年,皮瓣外形满意,手功能恢复良好.12例缝合指神经者,皮瓣两点分辨觉为10～12 mm.结论 穿支蒂皮神经营养血管皮瓣手术简便,血供可靠,可重建感觉功能,是修复手部创面的良好方法.     

前臂及拇背侧皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨前臂及拇背侧带皮神经营养血管蒂岛状皮瓣临床应用的适应证。方法利用以前臂外侧皮神经营养血管为蒂的岛状皮瓣修复拇指末节脱套伤2例,带拇背桡侧皮神经营养血管蒂岛状皮瓣及尺背侧皮神经营养血管蒂逆行岛状皮瓣修复拇指掌侧软组织缺损10例。皮瓣切取面积2cm×3cm～7cm×11cm。结果11例皮瓣全部成活,1例前臂外侧皮神经皮瓣因切取面积较大导致远端部分坏死。结论以前臂皮神经营养血管为蒂的岛状皮瓣适用于拇指末节脱套伤,但皮瓣长度不应超过11cm;拇背侧皮瓣宽度较小,仅适宜修复拇指较小面积的软组织缺损。     

皮神经伴行血管蒂逆行岛状皮瓣的临床应用

目的 :探讨皮神经伴行血管蒂逆行岛状皮瓣的临床应用。方法 :使用前臂外侧皮神经伴行血管蒂逆行岛状皮瓣修复腕掌、腕背及虎口部皮肤软组织缺损 5例。腓肠神经伴行血管蒂逆行岛状皮瓣修复小腿远端、足跟足背皮肤软组织缺损 10例。皮瓣切取面积 5 cm× 5 cm～ 15 cm× 9cm。结果 :15例皮瓣 ,13例完全成活。1例皮瓣远端边缘 0 .5 cm坏死 ,经换药后愈合。 1例皮瓣坏死 ,创面植皮后愈合。结论 :皮神经伴行血管蒂逆行岛状皮瓣血供可靠 ,切取简便、安全 ,不牺牲主要血管 ,是修复四肢皮肤软组织缺损较好的方法之一     

腓动脉穿支蒂腓肠神经营养血管皮瓣的临床应用

目的探讨应用改进腓肠神经营养血管皮瓣修复小腿下段及足踝部皮肤软组织缺损的手术方法及临床效果。方法1999年1月~2004年11月,在腓动脉肌间隔支与腓肠神经血供的解剖基础上临床应用22例。其中男14例,女8例。年龄5~54岁。根据缺损部位及大小设计以腓动脉小腿下段穿支为血管蒂及转轴点,沿腓肠神经营养血管轴线切取皮瓣,逆行移位修复小腿下段及足踝部皮肤软组织缺损。应用腓动脉终末穿支蒂皮瓣13例,腓动脉第2穿支蒂皮瓣8例,第3穿支蒂皮瓣1例。切取皮瓣范围13 cm×12 cm~30 cm×20 cm,穿支血管蒂长1.7~3.0 cm,穿支血管蒂发出部位位于外踝上4.5~8.0 cm,血管外径1.0~1.2 mm。结果术后22例皮瓣全部成活,随访6~18个月,皮瓣外形及功能恢复满意。其中4例腓肠神经与受区感觉神经吻合,术后1年感觉恢复好,两点辨别觉为10~13 mm。结论腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作简便,血供可靠,切取面积大,适用于修复小腿下段及足踝部大面积皮肤软组织缺损。     

小腿血管穿支蒂皮神经营养血管皮瓣的临床应用

目的报道应用胫后动脉穿支蒂隐神经营养血管皮瓣及腓动脉终末穿支蒂腓肠神经营养血管皮瓣修复小腿下段及足部软组织缺损的临床效果。方法以胫后动脉穿支或腓动脉终末穿支发出点为血管蒂，沿隐神经或腓肠神经轴线切取皮瓣，逆行修复小腿下段及足部皮肤缺损。其中，胫后动脉穿支蒂隐神经营养血管皮瓣13例，面积5cm×4cm-15cm×8cm，腓动脉终末穿支蒂腓肠神经营养血管皮瓣16例，面积16cm×8cm～30cm×10cm。结果临床应用29例，术后皮瓣全部成活，随访12—28个月，皮瓣质地良好，外观及功能恢复满意。结论应用小腿血管穿支蒂皮神经营养血管皮瓣，修复小腿下段及足部皮肤缺损，可获得较好的临床效果。     

腓动脉终末穿支蒂腓肠神经营养血管皮瓣的临床应用

目的报道改进腓肠神经营养血管皮瓣的手术方法及临床应用效果.方法在解剖观测基础上设计以腓动脉终末穿支为血管蒂,沿腓肠神经营养血管轴线切取皮瓣转位修复小腿下段及足踝部皮肤软组织缺损.结果临床应用7例,皮瓣全部成活,皮瓣面积30cm×10cm～23cm×8cm,穿支血管蒂长1.6～3.0cm.随访6～12个月,皮瓣质地优良,外形与功能改善满意.结论该术式扩大了皮瓣的切取面积及修复范围,皮瓣血供可靠,手术简便,适用于修复小腿下段及足踝部大面积皮肤软组织缺损.     

逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝部软组织缺损

目的报道逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复足踝关节周围软组织缺损的手术方法和临床效果。方法对48例足踝关节周围皮肤软组织缺损的患者采用逆行胫后动脉穿支蒂隐神经营养血管(肌)皮瓣修复,单纯逆行胫后动脉穿支蒂隐神经营养血管皮瓣39例,肌皮瓣9例;其中胫后动脉穿支筋膜蒂神经营养血管皮瓣29例,胫后动脉穿支血管蒂营养血管皮瓣19例,软组织缺损大小12 cm×9 cm~4 cm×3 cm,皮瓣面积13 cm×9.5cm~6 cm×5 cm。结果 43例皮瓣完全存活,5例皮瓣远端部分坏死,经积极换药、清创植皮修复。皮瓣术后轻度肿胀,无感染及淤血,皮瓣蒂部无臃肿。术后随访6~18个月,皮瓣质地优良,肢体外形与功能恢复满意,供区植皮术后恢复保护性感觉。结论胫后动脉穿支蒂隐神经营养血管皮瓣血供可靠,质地优良,是修复足踝关节周围软组织缺损的良好选择。     

浅静脉皮神经营养血管蒂逆行皮瓣修复手部皮肤缺损

目的报道三种吻合浅静脉的皮神经营养血管蒂逆行岛状皮瓣转位术的临床疗效.方法从1998年7月～2001年3月应用三种吻合浅静脉的皮神经营养血蒂管皮瓣修复手部皮肤软组织缺损16例,皮瓣最大面积20cm×8cm,最小面积4cm×3cm,其中头静脉桡神经浅内侧支营养血管皮瓣4例,贵要静脉前臂内侧皮神经营养血管皮瓣5例,头静脉前臂外侧皮神经营养血管皮瓣7例.结果 16例皮瓣均顺利成活,皮瓣未出现明显肿胀及瘀血.结论皮神经营养血管皮瓣逆行转位后,吻合一条浅静脉对皮瓣的顺利成活、肢体的静脉回流及皮瓣的超大面积切取具有积极的意义.     

腓肠神经营养血管皮瓣修复足踝部皮肤缺损

目的 探讨改进腓肠神经营养血管皮瓣修复足踝部皮肤软组织缺损的方法及效果.方法　2003年1月至2011年1月,在腓动脉穿支与腓肠神经营养血供的解剖基础上,根据足踝部皮肤缺损大小,设计腓肠神经营养血管皮瓣,逆行移位修复足踝部皮肤软组织缺损13例.切取皮瓣而积9 cm×8.5 cm～ 28 cm×13 cm,穿支血管蒂长1.7～3.3 cm.结果　本组中11例皮瓣全部存活,2例皮瓣远端边缘坏死,经换药治愈.全部患者随访6～12个月,皮瓣外形及功能满意.结论　腓动脉穿支蒂腓肠神经营养血管皮瓣手术操作简便,血供可靠,切取面积大,适用于修复足踝部大面积皮肤软组织缺损.     

吻合血管的骨间背皮瓣移植修复手指皮肤缺损

目的游离长蒂骨间背侧穿支感觉皮瓣修复手指皮肤缺损。方法急诊或择期行同侧骨问背侧穿支感觉皮瓣修复手指皮肤缺损8例；其中单纯皮肤缺损4例，各关节主及被动活动正常；合并肌腱伤或骨折者4例，关节主动活动有不同程度影响。皮瓣大小：3、5cm×2cm～5cm×3cm；端端吻合骨间背侧动脉-指固有动脉，伴行静脉-指掌侧浅静脉，前臂后侧皮神经-指固有神经。术后定期测量两点辨别觉、外观满意度及关节活动度，评估手术效果。结果本组皮瓣全部存活，无1例发生血管危象，两点辨别觉8～18mm。外观满意度评估优5例，良3例。结论长蒂骨间背侧穿支感觉皮瓣是修复手指尤其是指端及指腹皮肤软组织缺损的一种较好方法。     

Modified distally based sural neuro-veno-fasciocutaneous flap: anatomical study and clinical applications

The distally based sural neuro-veno-fasciocutaneous flap has been used widely for reconstruction of foot and ankle soft-tissue defects. The distal pivot point of the flap is designed at the lowest septocutaneous perforator from the peroneal artery of the posterolateral septum, which is, on average, 5 cm (4-7 cm) above the lateral malleolus. A longer neuro-veno-adipofascial pedicle would be needed to reversely reach the distal foot defect when the flap is dissected based on this perforating branch, which may result in more trauma in flap elevation and morbidity of the donor site. In this article, we explored new pivot points for this distally based flap in an anatomic study of 30 fresh cadavers. The results showed that the peroneal artery terminates into two branches: the posterior lateral malleolus artery and lateral calcaneal artery. These two branches also send off cutaneous perforators at about 3 and 1 cm above the tip of lateral malleolus, respectively, which can be used as arterial pivot points for the flap. A communicating branch between the lesser saphenous vein and the peroneal venae comitantes was found, accompanied by the perforator of the posterior lateral malleolus artery. This modified, distally based sural flap with lower pivot points was successfully transferred for repair of soft-tissue defects in 21 patients. The size of flaps ranged from 4 x 3 cm to 18 x 12 cm. All flaps survived without complications. Neither arterial ischemia nor venous congestion was noted. In conclusion, the vascular pivot point of a distally based sural flap can be safely designed at 1.5 cm proximal to the tip of the lateral malleolus. This modified flap provides a valuable tool for repair of foot and ankle soft-tissue defects.     

以骨间后血管为蒂的前臂后侧皮神经营养血管皮瓣在手部创伤修复中的应用

目的 报告应用改进前臂后侧皮神经营养血管逆行皮瓣的手术方法及临床效果.方法 设计以骨间背侧血管下段为蒂的前臂后侧皮神经营养血管皮瓣逆向转位修复手腕背以远的皮肤缺损创面.临床应用22例,皮瓣最远修复至近侧指间关节,皮瓣最大切取面积为14cm×10 cm,蒂部最长12 cm.结果 术后22例皮瓣全部存活,未发生血管危象.随访时间为6～12个月,皮瓣质地优良,外形与功能恢复满意.结论 经改进后的前臂后侧皮神经营养血管皮瓣可用于修复手部较大面积的皮肤软组织缺损.     

Reconstruction of limb soft-tissue defects: using pedicle perforator flaps with preservation of major vessels, a report of 45 cases

SUMMARY: We report on 45 pedicle perforator flaps without harvesting major vessels in limb reconstruction. Of our patients, 25 had major vessel injury resulting from their initial injury. In the upper extremities, there were 13 posterior interosseous artery perforator flaps, four ulnar artery perforator flaps and three radial artery perforator flaps. In the lower extremities, there were 16 peroneal artery perforator flaps with an axis on the sural nerve, five peroneal artery perforator flaps with an axis on the superficial peroneal nerve and four posterior tibial artery perforator flaps with an axis on the saphenous nerve. There were 42 successes, one total flap loss, one epidermal necrolysis and one distal tip necrosis. Greater utilisation of pedicle perforator flaps probably will occur because they are technically simple to execute, violate only the involved extremity, do not sacrifice a major source vessel, bring similar local tissues into a defect, avoid prolonged immobilisation and do not require microsurgical expertise. The concept of the pedicle perforator flap can be applied to the same axis of a neurocutaneous flap, even in cases with injured cutaneous nerves.     

Extending the reach of island cutaneous flaps

The advancement of island cutaneous flaps beyond 2 cm is facilitated by an understanding of underlying vascular anatomy. Recent studies demonstrate the perforating cutaneous blood vessels of the body. When extensive mobility is required, an island cutaneous flap should be centered over these vessels. The perforating cutaneous vessels and, if necessary, the axial vessels are identified, which permits vigorous dissection of restraining fascia and muscle. Clinical experience during the past 14 years suggests that the medial face is an ideal location for island cutaneous flaps. Flap design in the trunk and extremities incorporates known septal and subcutaneous fascial perforators. Fourteen of 53 island cutaneous flaps were advanced distances greater than 2 cm without significant complications.     

Skin perforators of back region: anatomical study and clinical applications

BACKGROUND: Despite widespread studies that have been commonly performed recently on skin perforators and perforator flaps of various regions of the body, investigations on the back region of the body are still insufficient. This study investigates the anatomical characteristics and clinical applications of perforating vessels in the back region. MATERIALS AND METHODS: The skin on the back region between the right and left, 7th to 11th thoracic vertebrae of 10 fresh cadavers were raised as flaps. Perforating vessels perfusing the skin with pedicle diameters of over 1 mm were included in the study. The anatomical localization, diameter, pedicle size, and the supplying vessels of these pedicles were determined. Utilizing this information, the defects of 8 patients with large meningomyeloceles included in the study were closed with prepared intercostal artery perforating flap. RESULTS: Perforators of the back region were seen to originate from the posterior intercostal vessels. There were a higher number of perforators on the right side of the body. The most commonly observed perforators were the 7th and 9th posterior intercostal perforators, and their diameters were larger. All flaps were viable following perforator flap closure for defects in 8 patients with large meningomyelocele included in the clinical study. No problems were encountered in the postoperative 3-month follow-up of cases. CONCLUSION: Owing to the low donor area morbidity and wide motion capabilities, the perforator flap is a new choice of flap for the back region. Perforator pedicle flaps supplied by the posterior intercostal vessels may be safely used in congenital tissue defects, such as meningomyelocele, tumors, and traumatic defects.     

以肩胛下血管为蒂的侧胸皮瓣修复上肢组织缺损

目的 探讨以肩胛下血管为蒂的侧胸皮瓣带蒂转移修复上肢较大面积组织缺损的可行性及临床效果. 方法 2003年6月至2009年9月,我们对5例上肢较大面积组织缺损的患者,应用以肩胛下血管为蒂的侧胸皮瓣带蒂转移修复,皮瓣切取面积为23 cm×8 cm～40 cm ×20 cm.术中将肩胛下血管、胸背血管和胸背血管外侧支及其皮穿支等营养血管均包含于皮瓣内.为了减少肌皮穿支的损伤,应在其周围携带2～3 cm宽的背阔肌袖.供瓣区创面直接缝合或移植皮片修复. 结果 单纯侧胸皮瓣带蒂转移4例、侧胸-脐旁联合皮瓣带蒂转移1例.转移的皮瓣除1例远端小部分坏死外,其余全部成活.4例患者获得2～14个月的随访,皮瓣色泽、质地及厚薄较满意,供、受区外形与功能恢复也较满意. 结论 带蒂转移的以肩胛下血管为蒂的侧胸皮瓣血供可靠,转移方便,供瓣区损伤小,是修复上肢较大面积组织缺损的理想方法.     

以上肢浅表皮神经伴行血管为蒂的岛状皮瓣的解剖学研究

对上肢浅表皮神经及其伴行血管与皮肤血供的关系进行显微解剖学研究后,设计出以上肢浅表皮神经伴行血管为蒂的岛状皮瓣。方法:新鲜成人上肢标本22侧,从肱动脉灌注红色乳胶后,对上肢浅表皮神经及伴行血管进行显微解剖。结果:(1)所有上肢皮神经都有来源于上肢知名血管的营养血管伴行。(2)与上肢浅表皮神经的伴行血管既营养神经,同时沿途又发出分支营养皮肤。(3)皮神经的伴行血管穿出深筋膜的部位有一定的规律性。结论;(1)上肢浅表皮神经的伴行血管为蒂的岛状皮瓣血供可靠,静脉回流充分,并可形成逆行蒂或顺行蒂岛状皮瓣。(2)以第2、3掌背皮神经伴行血管为蒂的岛状皮瓣,神经行走变异较多,伴行血管不稳定,临床选用时须慎重考虑。     

A reversed superficial peroneal neurocutaneous island flap based on the descending branch of the distal peroneal perforator: clinical experiences and modifications

The distally based neurocutaneous flaps have been popular for lower leg and foot reconstruction. On the basis of pre-existing anatomic studies and clinical experiences, we designed a reversed superficial peroneal neurocutaneous island flap with the descending branch of the distal peroneal perforator as the pedicle. The flap is supplied through both axial perforator and longitudinal chain-linked vascular plexuses. This modified neurocutaneous island flap, measuring around 5 cm x 4 cm to 12 cm x 13 cm in size, was transferred for coverage of foot soft-tissue defects in 21 cases with a low complication rate. Compared to the original neurocutaneous flap, the rotation point of this flap is more distal and the pedicle is thinner. It could provide good texture and contour matching to the recipient area. In conclusion, the modified neurocutaneous island flap provides a reliable tool for repairing soft-tissue defects of the ankle and foot.     

双轴点掌背皮动脉皮瓣修复腕手指软组织缺损

目的探讨应用双轴点掌背皮动脉皮瓣修复腕或手指软组织缺损的手术方法及其疗效. 方法 1995年～2003年,通过解剖学研究发现,由掌背动脉发出的近侧及远侧皮支在皮下组织内形成恒定的弓状动脉吻合,以其近侧或远侧皮支为蒂,手背皮肤为供区,可形成顺行或逆行岛状皮瓣.临床应用了27例,采用顺行修复手背3例,皮瓣范围2.0 cm×4.0 cm～4.0 cm×6.0 cm;逆行修复手指24例,其中食指12例,中指6例,环指4例,小指2例,皮瓣范围 2.5 cm× 3.5 cm～3.0 cm×7.0 cm.供区均直接闭合. 结果术后皮瓣均成活.经1～3年随访,皮瓣外形及手功能满意,术后3个月开始恢复感觉,1年后恢复保护性感觉.供区外形及功能正常. 结论以掌背皮动脉为蒂的顺行或逆行皮瓣修复腕或手指软组织缺损,是一种较好的手术方法.