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     

皮神经伴行血管蒂逆行岛状皮瓣的临床应用

１９９２年Ｂｅｒｔｅｌｉ等［１］报道以皮神经血供的岛状皮瓣以来，１９９４年宋建良等［２］用手部皮神经伴行血管逆行岛状皮瓣修复指端缺损获得成功；１９９７年芮永军等［３］对手部浅表皮神经伴行血管为蒂的岛状皮瓣进行了解剖学研究。１９９５年起，我们采用不同皮...     

隐神经伴行血管蒂岛状皮瓣蒂部成分对皮瓣血运的影响

目的 研究皮神经伴行血管蒂岛状皮瓣蒂部各成分对皮瓣血运的影响。方法 16只豚鼠,应用活体超大面积隐神经伴行血管蒂岛状皮瓣切取后美兰灌注法,平均动脉压灌注10分钟,观测染色面积和着色度,根据正交设计原理对蒂部成分进行了五因素、二水平L16^215正交实验和分析。结果 隐神经伴行动脉、静脉及其交互作用对染色面积的影响有显著性意义：皮肤、深筋膜、皮神经、皮神经营养血管网的2～5部分对染色面积的影响无显著意义。结论 隐神经伴行血管及其皮支是该皮瓣的营养血管,皮肤、深筋膜、皮神经、皮神经营养血管内的2～5部分对皮瓣血运的影响无显著意义,     

上肢皮神经伴行血管蒂岛状皮瓣逆行转移修复上肢软组织缺损

目的总结上肢皮神经伴行血管蒂岛状皮瓣修复手、腕、前臂远端软组织缺损的治疗效果,探讨其手术的适应性。方法应用前臂外侧皮神经、桡神经拇背侧支伴行血管蒂岛状皮瓣修复10例手、腕、前臂远端软组织缺损。结果7例成活,2例坏死,1例部分坏死。结论该类皮瓣操作简便、损伤小,前臂外侧皮神经伴行血管蒂岛状皮瓣是修复前臂、腕部软组织缺损的较好皮瓣,可用于修复手掌部桡侧的软组织缺损,但该皮瓣的血供和转移范围还需进一步研究。     

以手部皮神经伴行血管为蒂的岛状皮瓣的临床应用

目的应用手部皮神经伴行血管蒂岛状皮瓣修复手指指背软组织缺损。方法采用手部桡神经浅支、尺神经手背支伴行血管蒂的岛状皮瓣，即拇指桡、尺侧皮神经伴行血管岛状皮瓣修复拇指；第一掌背皮神经伴行血管岛状皮瓣修复示指；第三、四掌背皮神经伴行血管岛状皮瓣修复中、环指；小指尺背侧皮神经伴行血管岛状皮瓣修复小指。共５种１５块，修复指部皮肤缺损１５例。皮瓣切取的最大面积达５ｃｍ×３ｃｍ。结果１５例皮瓣全部成活，效果满意。结论该类皮瓣血供可靠，创伤小，操作简单。特别适用于一期修复伴有伸肌腱缺损的指背创面     

以皮神经营养血管为蒂岛状皮瓣的基础研究

目的　阐述以皮神经营养血管为蒂岛状皮瓣的成活机制 ,以及它与筋膜蒂、静脉蒂岛状皮瓣三者的关系。方法　以新西兰大白兔为动物模型 ,根据以筋膜、静脉、皮神经三者相互组合为蒂 ,设计出 7组不同类型的皮瓣 ,每组 3只。应用放射性核素99mTcO-4 和99mTc -MAA来测定皮瓣的动脉供血和毛细血管静脉回流情况 ,以及与皮瓣成活的关系。结果　单纯以筋膜、静脉、皮神经为蒂的岛状皮瓣全部坏死。D组皮瓣 (蒂部组织为小隐静脉和筋膜组织 )成活率为 [(6 8.5 1± 5 .41) % , x±s ,下同 ] ,E组皮瓣(蒂部组织为小隐静脉和腓肠神经 )成活率为 (94.2 4± 3 .2 2 ) %。F组皮瓣 (蒂部组织为筋膜组织 ,含腓肠神经无小隐静脉 )成活率为 (73 .41± 6 .12 ) %。G组皮瓣 (蒂部组织为筋膜组织 ,含腓肠神经和小隐静脉 )成活率为 (98.5 4± 1.12 ) %。放射性核素99mTcO-4 检测结果 :皮神经营养血管蒂较单纯的筋膜蒂、静脉蒂有充分的动脉供血。包含浅静脉的皮瓣中 ,皮神经营养血管蒂皮瓣的99mTco-4 清除率最快。结论　神经旁组织因含有与神经伴行的营养血管 ,其分支与皮下血管网相吻合对皮瓣提供动脉供血 ;浅静脉对皮瓣提供血液回流 ,使皮瓣血液循环更为通畅。神经旁带少量 (0 .2cm)筋膜组织 ,可保证手术时蒂部神经营养血管不被破     

手及前臂皮神经营养血管蒂皮瓣的应用解剖

目的：观察手及前臂皮神经营养血管的情况，为设计以皮神经及其营养血管为蒂的岛状皮瓣提供形态学依据。方法：用红色氯仿油画染料灌注的20侧成人上肢标本，在手术显微镜下解剖并观测手及前臂 5条皮神经营养血管的来源、数目、外径，穿出深筋膜的位置，与皮神经及浅静脉的关系等项目。结果；营养动脉多以降支方式伴行在皮神经深面内侧，前臂皮神经的血管网可达神经两侧各2．5cm范围内的皮肤，5条皮神经的营养动脉外径接近，结论：手及前臂皮神经的营养血管血供可靠，可设计相应部位的岛状皮瓣。     

皮神经营养血管皮瓣的基础研究及临床应用

1991年 ,Bertelli等[1] 研究了前臂内侧、外侧皮神经的伴行营养血管 ,提出了皮神经皮瓣的概念。1992年 ,他又报道了手背部神经皮瓣的临床应用[2 ] 。同年 ,Masquelet等[3 ] 介绍了小腿感觉神经血管轴为蒂的岛状皮瓣的概念 ,并将 3种下肢神经营养血管皮瓣应用于临床。此后 ,不同供区来源的神经皮瓣相继问世 ,作为 2 0世纪 90年代一种新皮瓣 ,愈来愈受到重视。1　神经营养血管皮瓣成活机理1 1　解剖学基础1 1 1　神经旁血管网　Bertelli等[1,2 ,4 7] 认为 :皮肤和神经的血运联系密切 ,都是由神经皮穿支供应。神经旁小的纵行血管连接着上述穿…     

以股后皮神经伴行血管为蒂的岛状皮瓣的应用解剖及临床意义

目的：为以股后皮神经伴行血管为蒂的岛状皮瓣的临床应用提供解剖依据。方法：在２７侧成人下肢标本上观察股后皮神经伴行血管的行程、外径及皮支分布情况。结果：（１）所有股后皮神经都有来源于知名血管的营养血管伴行。（２）股后皮神经的伴行血管既营养神经,同时沿途又发出多条分支营养皮肤,并与股后穿动脉皮支、动脉的升皮支广泛的吻合。（３）股后皮神经伴行血管穿出深筋膜有一定规律性。结论：股后皮神经伴行血管解剖恒定,口径较粗,具有形成岛状皮瓣顺行或逆行转移的解剖学条件。     

四肢带皮神经营养血管蒂岛状皮瓣的临床应用

目的探讨四肢各类型皮神经营养血管蒂岛状皮瓣修复组织缺损的临床效果.方法临床分别应用了5种皮神经营养血管蒂岛状皮瓣修复皮肤、软组织缺损8例的实践.皮瓣最大面积15cm×10cm,最小面积3.5cm×2.5cm.结果8例皮瓣均成活良好,创面Ⅰ期愈合,经6～12月随访,效果满意.结论四肢带皮神经营养血管蒂岛状皮瓣血供可靠,不牺牲主要血管,是修复四肢皮肤软组织缺损的一种好方法.     

带皮穿支血管的皮神经营养血管皮瓣的临床应用

目的探讨带皮穿支血管与皮神经营养血管相结合的皮瓣手术方法及临床应用效果。方法以深部知名血管发出的皮肤穿支为皮瓣转轴点,切取皮神经营养血管带蒂皮瓣或岛状皮瓣,转位修复肢体远端皮肤软组织缺损创面。结果临床已应用43例,其中腓动脉穿支腓肠神经营养血管皮瓣13例,面积30 cm×12 cm~16 cm×8 cm;胫后血管穿支隐神经营养血管皮瓣9例,面积17 cm×9 cm~5 cm×4 cm;以骨间前血管腕背穿支前臂背侧皮神经营养血管皮瓣8例,面积16 cm×6 cm~10 cm×4 cm;以掌指动脉指蹼穿支手背皮神经营养血管逆行皮瓣13例,皮瓣面积6.0 cm×3.5 cm~2.5 cm×1.5 cm;皮瓣完全成活42例,1例因静脉回流障碍远端1/4坏死。随访6~24个月,皮瓣质地优良,外形与功能恢复满意。结论该术式结合了穿支蒂皮瓣与皮神经营养血管皮瓣的优点,扩大了皮瓣切取面积与修复范围,皮瓣设计灵活,切取方便,血供可靠,是修复肢体皮肤软组织缺损的一种可取的方法。     

两套血供的小腿外侧皮瓣逆行转位修复足踝部软组织缺损

目的 介绍两套血供的改良小腿外侧皮瓣逆行转位修复老年人足踝部软组织缺损的临床体会。 方法 对足踝部软组织缺损、创面骨肌腱外露、需作皮瓣修复的老年病例,在传统的小腿外侧逆行岛状皮瓣及穿支带腓肠神经营养血管逆行岛状皮瓣的基础上,利用小腿外侧皮瓣中下段穿出的骨皮动脉皮支及腓肠神经营养血管皮瓣的供血穿支均发自腓动脉的特点,将皮瓣设计于小腿后外侧,用兼顾传统小腿外侧皮瓣及腓肠神经营养血管皮瓣在供m范围的重叠区域而形成两套血供的改良小腿外侧逆行岛状皮瓣修复。结果临床共应用11例,所有皮瓣术后均顺利成活,供区植皮愈合良好,经3～9个月随访,6例皮瓣外观满意,踝关节伸屈功能正常,基本恢复行走功能;5例合并伸肌腱缺损者3个月后作肌腱移植重建后恢复行走功能。 结论 采用两套血供的改良小腿外侧皮瓣逆行转位是修复老年人足踝部软组织缺损的好方法。     

A neurocutaneous island flap model: an experimental study in rats

Neurocutaneous flaps have been popularized recently in clinical reconstructive surgery. However, controversies exist concerning their anatomy and physiology. The particular role of neural vasculature in the survival of these skin flaps is also quite undefined in the experimental setting, and additional studies on this subject are necessary. The goal of this study was to describe a neurocutaneous flap in a rat model and to investigate its blood supply. Thirty male Sprague-Dawley rats weighing 300 to 350 g were used in this study, which was conducted in two stages. During the first stage, the lower extremities of 10 rats were dissected for the anatomic study of the neurocutaneous flap. A constant cutaneous nerve innervating the anterolateral thigh skin was exposed. It arose either from the saphenous nerve or the superficial epigastric nerve and was accompanied by a constant longitudinal arterial plexus. The tiny neural vessels were conveyed by the superficial fascia along their course. A 30 x 30-mm cutaneous island flap, which was based only on the cutaneous nerve with its accompanying vessels and a strip of superficial fascia, was raised on the anterolateral thigh skin using an operating microscope. The well-perfused skin territory was marked after sodium fluorescein injection. The stained skin territory was located centrally and medially on the whole island flap, and it was approximately 10 x 20 mm. This finding was confirmed by the qualitative assessment of the vascularity for this skin territory in microangiography. After studying the pedicle anatomy and determining the optimal viable skin island, the second stage of the study was performed. The remaining 20 rats were divided into two groups. In the experimental group (N = 10), a neurocutaneous island flap (10 x 20 mm) was outlined on the anterolateral aspect of the thigh at its middle third. It was designed in such a way that its short and long axes lay in the center of the distance between the anterior superior iliac spine and the anterior aspect of the knee joint. After identification and dissection of the neurovascular pedicle, the flap was raised in a lateral-to-medial direction without including the deep fascia. At this point the flap remained connected only by the pedicle and a strip of superficial fascia surrounding it. It was sutured in the same place. In the control group (N = 10), the pedicle of the flap was severed and the skin island was sutured back as a composite graft. All the experimental flaps survived well. In the control group, none of the flaps survived except one that was partially viable. The flaps in the experimental group were reelevated as neurocutaneous island flaps on day 7 for microangiographic study, and specimens were processed for histologic staining. Microangiography revealed the extent of neural vasculature and vascularization of the skin through cutaneous perforators. Histologic investigation demonstrated the neural vessels that were related closely to the superficial fascia. The authors propose a neurocutaneous island flap model in the lower extremity of the rat in which the survival of the flap depended mainly on the neural arterial supply. It was also demonstrated that the superficial fascia played a role as a connective tissue framework for conveying tiny neural blood vessels to reach the skin. This model may serve as a reproducible and reliable neurocutaneous island flap model for additional studies in this field.     

Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm

The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.     

皮神经营养血管逆行岛状皮瓣修复肢体远端组织缺损

目的分析皮神经营养血管逆行岛状皮瓣修复肢体远端组织缺损的适用性。方法应用皮神经营养血管逆行岛状皮瓣修复30例患者肢体远端组织缺损，其中前臂外侧皮神经营养血管带蒂移植5例，腓肠神经营养血管带蒂移植11例，隐神经营养血管带蒂移植14例。所有被修复创面均有不同程度的血管、神经、肌腱或（和）骨质外露。结果1例患儿术后因蒂部受压致皮瓣远端部分坏死，经换药治愈；1例患者因术后感染，皮瓣周边成活不良，经肉芽植皮术后治愈；其余28例患者所植皮瓣全部成活，血运良好，修复部位外观及功能恢复较为满意。结论皮神经营养血管逆行岛状皮瓣解剖结构恒定，血供可靠，手术操作简单，不损伤主要血管及肌肉组织，适用于肢体远端组织缺损的修复。     

掌、指背皮神经营养血管逆行岛状皮瓣修复手指皮肤缺损

目的 分析应用掌、指背皮神经营养血管蒂逆行岛状皮瓣修复手指皮肤缺损的疗效.方法 应用掌背皮神经营养血管蒂逆行岛状皮瓣18例(18块),带指神经背侧支的指背逆行岛状皮瓣15例(17块),修复手指皮肤缺损.观察皮瓣的成活率、质地、色泽和感觉.结果 术后皮瓣发生肿胀2例,静脉危象2例.33例35块皮瓣全部存活.术后随访时间为3～18个月,平均12个月.皮瓣外观、质地、弹性良好,有部分浅感觉恢复.结论 掌、指背皮神经营养血管蒂逆行岛状皮瓣不损伤主要血管、神经,操作简单,是修复手指创面的理想方法.     

小腿皮神经伴行血管蒂皮瓣的解剖及临床应用

目的 探讨小腿皮神经伴行血管皮瓣的血供方式及应用的可靠性。方法 对３２侧婴儿和２侧成人肢新鲜标本灌注后解剖观察,并应用小腿皮神经伴行血管皮瓣修复５例外伤后轸组织缺损。结果 ①４条主要的皮神经在穿出深筋模时,均有皮动脉胖行,但伴行方式不尽相同。②在小腿中上段以轴型血管为主,中下段以“链条式”连接的伴行血管为主。③由此设计的皮瓣应各有差异,临床应用５例全部成活。结论 ①沿皮神经走向设计的筋膜皮瓣血供可