逆行腓肠神经营养血管岛状皮瓣的临床应用

目的了解逆行腓肠神经营养血管岛状皮瓣的治疗效果。方法以逆行腓肠神经及其滋养血管为蒂的小腿后侧岛状皮瓣，修复小腿下段、踝部、足部软组织缺损12例。切取皮瓣范围(4cm×4cm)～（12cm×10cm)，血管蒂长6～14cm。结果术后皮瓣全部成活，未发生血管危象。随访2～12个月，外观功能恢复良好，6个月后感觉部分恢复。但皮瓣外观臃肿。尝试3例自蒂部结扎小隐静脉，其皮瓣外观肿胀程度较未结扎者轻。结论腓肠神经伴行血管岛状皮瓣血供可靠，转移范围大，损伤小，操作简便，可用于修复小腿前侧，踝部及足近侧二分之一软组织缺损，对伴有主要血管损伤的病例更有特殊意义。缺点是外观臃肿。在小面积皮瓣中尝试蒂部结扎小隐静脉减轻皮瓣肿胀获得成功，但在大面积皮瓣中的应用价值尚待研究。

Clinical application ofthe island flap pedicled with collateral vessel nourished by retrograde sural nerve

Objective　To sum up the application of the retrograde sural nerve island flap pedicled with the concomitant vessels.Method　From February 1997 to June 2000,the retrograde-flow sural nerve island flaps pedicled with collateral vessels were performed to repair the soft tissues defect of the shank in 3 cases, ankle in 3 cases and foot in 6 cases. The range of flap was 4?cm×4?cm～12?cm×10?cm,the length of pedicle was ranged from 6?cm to 14?cm.Results　All the flaps survived completely without vascular crisis.Followed up for 2 to 12 months,the flaps had fine appearance and function, the sensation of flap partially recovered after 6 months. The appearance of 3 cases whose small saphena vein were ligated were better than the others.Conclusion　The flap has reliable blood supply，great rotation arc,small damage and simple operation.It is excellent for repairing the soft tissue defect in the anterior leg,ankle and proximal half of foot. It is more significant while the main blood vessels are damaged.