腓肠神经-小隐静脉逆行岛状肌皮瓣的局部解剖与临床应用

目的：介绍腓肠神经-小隐静脉逆行岛状肌皮瓣的局部血管解剖研究与临床应用经验。方法解剖3个成人小腿灌注标本，观察腓肠神经-小隐静脉血管轴与腓肠肌内外侧头肌支和肌皮穿支之间的吻合关系，根据观察结果设计以腓动脉肌间隔穿支供血的逆行岛状腓肠肌皮瓣修复4例足踝部创面，皮瓣面积10～16 cm ×6～9 cm。结果在腓肠神经穿出深筋膜前，腓肠神经-小隐静脉血管轴与两侧的腓肠肌肌支间各有2～4个吻合。在穿出深筋膜后，与两侧的腓肠肌肌皮穿支间各有2～3个吻合。在腓肠肌腱腹交界（约为小腿中点）的近侧2～4 cm 内，有1～3支肌皮穿支血管与腓肠神经血管轴相交通。据此设计的肌皮瓣完全成活。结论腓肠神经-小隐静脉逆行岛状肌皮瓣血供可靠、转移方便，较传统的腓肠神经营养血管皮瓣可切取面积更大，是修复足踝部组织缺损的好方法。

Regional anatomy and clinical application of retrograde island musculocutaneous flap pedicled with small saphenous vein and sural nerve

Objective To introduce the regional anatomy of retrograde island musculocutaneous flap pedicled with small saphenous vein and sural nerve nutrition and provide experiences for its clinical application.Methods Three injected adult samples of the lower limb were dissected for identification of anastomoses among the axis of small saphenous vein and sural nerve,the medial and lateral branches of the sural muscle and musculocutaneous branches.Based on these anatomic studies,the retrograde sural island flap（10 ~16 cm ×6 ~9 cm）supported by intermuscular branches of the peroneal artery was transferred for reconstruction of foot and ankle wounds in 4 cases.Results There were 2 ~4 anastomoses connecting the axis of small saphenous vein and sural nerve to the sural muscular branches before sural nerve pierced out of the deep fascia,and 2 ~3 anastomoses were observed after the piercing.Furthermore,at a location 2 ~4 cm proximal to the junction between tendon and belly（the midpoint of the lower limb）,there were usually 1 ~3 perforator vessels communicating the sural neurovascular axis.Flaps designed by above standard were all successfully transferred.Conclusion The retrograde island musculocutaneous flap pedicled with small saphenous vein and sural nerve increases incision areas,which is a reliable,versatile and simple method for foot and ankle tissue defects.