腓肠神经营养血管皮瓣的真性吻合连接及修复前足创面的疗效

目的　报道并分析腓肠神经营养血管皮瓣修复前足创面的临床疗效。 方法　选取5例肿瘤患者高位截肢的下肢标本，冲洗和灌注后，剥离体被组织摄X线片，观察腓肠神经营养动脉链内、腓动脉穿支间及这些穿支与动脉链间的真性吻合连接。临床行腓肠神经营养血管皮瓣修复前足创面52例。 结果　标本观察发现，腓肠神经营养动脉链内从踝间线至腘窝横纹、腓动脉远端2~3个穿支间及这些穿支与动脉链间均通过真性吻合连接。临床研究中皮瓣成活42例；部分坏死10例，予以1例Ⅱ期缝合、8例植皮、1例局部皮瓣转位后残留创面愈合。 结论　腓肠神经营养动脉链内、腓动脉远端2~3个穿支间及这些穿支与动脉链间的真性吻合连接，是腓肠神经营养血管皮瓣存活长度较长的血管解剖学基础，该皮瓣是修复前足创面的一种较好方法。

True anastomosis connections of sural neuro-vascular flap and outcomes of the flap for reconstructing soft tissue defect in forefoot

Objective　To discuss the clinical effects of the true anastomosis connections between the sural neuro-vascular flap and outcomes of the flap for reconstructing the soft tissue defect in the forefoot. Methods　Five amputated lower limbs were obtained from 5 patients with recurrent malignant bone tumor in the middle and/or upper femur. After being acquired, these specimens were irrigated and then perfused with a barium sulfate/red latex mixture immediately. The integuments of these limbs were stripped and radiographed. Anatomic observation focused on the true anastomosis connections within the arterial chain around the sural nerve, among the peroneal perforators and between these perforators and the arterial chain. Fifty-two sural neuro-vascular flaps were used to perform the soft tissue defects in the forefoot.　Results　The arterial chain surrounding the sural nerve was linked by true anastomoses from the intermalleolar line to popliteal crease. The distal 2 to 3 peroneal perforators were connected by true anastomoses of their longitudinal branches. Forty-two flaps survived. Partial necrosis occurred in 10 (19.2%) flaps, the remnant defects were successfully performed by secondary suture (n=1), skin grafting (n=8) and local flap transposition (n=1).　Conclusions　The true anastomosis connections within the arterial chain around the sural nerve, among the distal 2 to 3 peroneal perforators and between these perforators and the arterial chain, are the vascular anatomical basis of the sural neuro-vascular flap which survives with greater length. This flap is a better option for reconstruction of the soft tissue defect in the forefoot.