外侧皮动脉蒂小腿后侧皮瓣的解剖及临床研究

目的了解外侧皮动脉蒂小腿后侧皮瓣行吻合血管的游离移植可行性。方法对２２例成人下肢新鲜标本进行了解剖学观察测量。结果外侧皮动脉出现率１００％，其起始处外径１．２８±０．２５ｍｍ，血管走行恒定，并恒与腓肠外侧皮神经伴行，血管全长２０．０±５．７ｃｍ，远端与腓动脉穿支有联系。以此为蒂制成的小腿后侧皮瓣有伴行静脉及小隐静脉可供吻合，回流良好。临床应用此皮瓣行带神经的吻合血管的游离移植７例，均获成功。结论本游离皮瓣具有一定的优点，适用于中小面积或功能部位组织缺损的修复。     

胭外侧皮动脉蒂小腿后侧皮瓣的解剖及临床研究

目的了解腘外侧皮动脉蒂小腿后侧皮瓣行吻合血管的游离移植可行性。方法对22例成人下肢新鲜标本进行了解剖学观察测量。结果 腘外侧皮动脉出现率100％,其起始处外径1.28±0.25mm,血管走行恒定,并恒与腓肠外侧皮神经伴行,血管全长20.0±5.7cm,远端与腓动脉穿支有联系。以此为蒂制成的小腿后侧皮瓣有伴行静脉及小隐静脉可供吻合,回流良好。临床应用此皮瓣行带神经的吻合血管的游离移植7例,均获成功。结论本游离皮瓣具有一定的优点,适用于中小面积或功能部位组织缺损的修复。     

小腿外侧皮瓣修复手部皮肤缺损的临床应用

目的 探讨小腿外侧皮瓣修复手部皮肤缺损的临床应用.方法 对15例手部皮肤缺损面积大小约2.5 cm×3.2 cm～3.8 cm×5.0 cm的患者,采用小腿外侧皮瓣游离移植修复.皮瓣穿支动脉与手部动脉、伴行静脉或皮下静脉与手背静脉吻合,小腿供区创面直接缝合.结果 15例皮瓣全部存活,1例皮瓣术后出现血管危象,行手术探查重新吻合血管后存活,4例皮瓣术后3个月行皮瓣整形术.术后随访时间为2个月至2年,平均11个月,手部皮瓣外观满意,功能恢复良好;小腿供区隐蔽,创面仅留线状瘢痕.结论 小腿外侧皮瓣修复手部皮肤缺损是一种较理想的方法.     

小腿外侧腓动脉皮支皮瓣的解剖与临床应用

目的研究以腓动脉皮支血管为蒂的小腿外侧皮瓣吻合血管游离移植的解剖学与临床应用。方法解剖20具40侧成人尸体小腿,测量小腿外侧腓动脉皮支的有关数据。多普勒血管仪测定30侧成人活体小腿外侧腓动脉皮支血管穿出点。临床行21例小腿外侧腓动脉皮支皮瓣吻合血管的游离移植手术。结果40侧小腿共观察到皮支140支,每侧1~7支不等,平均3.5支,其中一侧只有1支高位皮支。皮支的穿出点大多(76%)在腓骨头最凸点下方7~21 cm范围。每侧最粗的皮支动脉外径平均为(1.8±0.4)mm(1.4~2.9 mm),两条伴行静脉外径平均(3.0±0.5)mm和(2.4±0.4)mm。30侧活体小腿共测到小腿外侧皮支血管穿出点145个,平均每侧4.8个。临床切取皮瓣大小5.0 cm×3.5 cm~28 cm×11 cm,21块皮瓣均成活。结论小腿外侧皮瓣由不同数目的腓动脉皮支供养,其主皮支能满足显微外科吻合血管的要求。以皮支血管为蒂的小腿外侧游离皮瓣移植,比以腓血管为蒂创伤小、操作简单、血运重建符合生理。     

吻合小隐静脉的腓肠神经营养血管逆行皮瓣的应用

腓肠神经营养血管蒂逆行岛状皮瓣已成功用于修复足踝部创面,但蒂部过长或面积过大时皮瓣远端常发生静脉危象。为此,我们将皮瓣的小隐静脉与受区皮下静脉作吻合,临床应用9例,效果满意。应用解剖腓肠内侧皮神经自胫神经发出沿腓肠肌内、外侧头间下行至小腿中段穿出深筋膜与发自腓总神经的腓肠外侧皮神经合成腓肠神经。窝中间皮动脉起自动脉,发出浅支供养小腿上部皮肤,深支与腓肠神经伴行下降至踝部,少数在小腿下段　　作者单位:570311　海南省海口市,海南省人民医院显微外科延续成动脉网,行程中与神经内血管及腓肠肌皮穿支广泛吻合并不断…     

股前外侧游离皮瓣修复足跟大面积软组织缺损

目的探讨股前外侧游离皮瓣移植修复足跟大面积创伤性软组织缺损的临床效果。方法1997年10月至2005年3月，应用股前外侧游离皮瓣移植修复足跟大面积软组织缺损26例，将旋股外侧动脉降支及其伴行静脉分别与胫后动静脉吻合，并将股外侧皮神经与隐神经或腓肠神经吻合，使皮瓣具有感觉功能，并将阔筋膜缝合固定于跟骨以增加皮瓣稳定性。结果移植皮瓣全部成活，创面一期愈合，经3个月至4年的随访，皮瓣感觉部分恢复，足跟外形与稳定性良好。结论股前外侧游离皮瓣供区隐蔽，血供丰富，可切取范围大，特别是带有感觉神经和阔筋膜，修复足跟耐磨、稳定性好，是修复足跟大面积软组织缺损的理想皮瓣。     

腓动脉穿支为蒂的腓肠外侧皮动脉逆行岛状皮瓣的应用解剖

采用２５例突因外伤致死的健康成人新鲜下肢５０侧，通过显微外科解剖，血管造影，染料试验等方法，探讨了本皮瓣的应用解剖学，其结论如下：腓肠外侧皮动脉出现率本组为１００％，主要来源于Ｇｕ动脉９１．９％。其动脉末端在外踝上１４．３１±３．８３ｃｍ处与腓动脉穿支形成吻合弓，为本皮瓣的血供来源。吻合弓的出现率本组为８８．６４％。皮瓣最佳形成部位为小腿上段后外侧。     

小腿后侧皮瓣的临床应用

198 1年Ｈａｅｒｔｓｃｈ报道小腿后侧皮瓣的应用解剖 ,1984年Ｒｏｂｅｒｔ报道应用该皮瓣行游离移植。 1994年以来我们在临床应用 2 1例 ,效果满意。手术方法皮瓣设计 :术前以多普勒血流仪测定标记外侧和中间皮动脉走行并以此为轴心设计皮瓣 ,上界平腓骨小头 ,下界可至内、外踝连线上 10ｃｍ ,宽可达 12～ 14ｃｍ。皮瓣切取 :沿窝外上方的股二头肌内侧缘体表投影作斜切口至腓骨小头下缘的腓总神经斜跨部 ,先寻出沿股二头肌内侧缘走行并斜跨腓骨小头下缘的腓总神经 ,然后在其稍内侧即可发现与其伴行的腓肠外侧皮神经及伴行的外侧皮…     

以腓动脉肌皮支为血管蒂的小腿外侧皮瓣

１９９０年２月至１９９２年２月，我院应用以腓动脉肌皮支为血管蒂的小腿外侧皮瓣游离移植修复手部创面８例，７例皮瓣全部成活，玉例部分坏死，疗效满意。此皮瓣的血供可来自起于脓动脉的比目鱼肌肌支、屈拇长肌肌支和直接皮支，三者动脉口径、血管蒂长度、供皮范围不一。比目鱼肌肌支动脉口径为０．６～１．２ｍｍ，血管蒂长达６～８．５ｃｍ，供皮范围可自小腿外侧上１／３至下１／３，故为首选。取度面积以１５ｃｍ×１０ｃｍ为宜。和传统小腿外侧皮瓣相比，具有手术操作方便，对下肢血供损伤小，不影响屈拇长肌阻力等优点，最适合修复手背、掌较大面积的皮肤缺损．     

带感觉神经的骨间背侧游离皮瓣修复手指皮肤缺损

目的探讨带感觉神经的骨间背侧游离皮瓣修复手指皮肤缺损的可行性。方法在12例前臂标本远1／3背侧设计游离皮瓣，记录骨间后血管皮支数、最粗穿支距尺骨小头上缘距离；记录营养皮瓣皮神经数目、直径；测血管蒂长度，记录血管蒂近端动脉及伴行静脉大小。临床应用带感觉神经的骨间背侧游离皮瓣修复手指皮肤缺损6例。结果骨间背侧动脉在前臂远1／3有1～5条皮穿支，最粗穿支距离尺骨小头上缘（43±17）mm。皮神经直径（0．40±0．13）mm，血管蒂长（105±21）mm，动脉直径大小（1．2±0．1）mm，静脉直径大小（1．1±0．2）mm。6例游离皮瓣全部存活，恢复了保护性感觉。结论前臂远1／3血供及神经解剖特点可使其成为带感觉神经游离皮瓣的供区，修复手指皮肤缺损。     

Sural perforator flap: Assessment of the posterior calf region as donor site for a free fasciocutaneous flap

Three kinds of free fasciocutaneous flap from the posterior calf region have been described in the literature: the medial sural perforator flap, the lateral sural perforator flap, and the traditional posterior calf fasciocutaneous flap that is supplied by superficial cutaneous vessels. Moreover, it has been reported that superficial cutaneous vessels are of a suitable size for microanastomosis when deep musclocutaneous perforators are absent or relatively tiny. To establish a safe technique for free fasciocutaneous flap elevation from the posterior calf region, we examined the number and location of the musculocutaneous perforators and the size of superficial cutaneous vessels at their origin from the popliteal artery in six formalinized cadavers. We found that all legs had at least one perforator either from the medial sural artery or the lateral sural artery. By contrast, we failed to find superficial cutaneous vessels of suitable size for microanastomosis in three legs, and there was no significant inverse relationship between the diameter of the superficial cutaneous artery and the number of musculocutaneous perforators. Our results suggest that the medial sural perforator flap and the lateral sural perforator flap might be the surgeon's first and second choice, respectively. The traditional posterior calf fasciocutaneous flap should be the third choice because our study suggests that its availability is doubtful. Another site is recommended, when preoperative Doppler study suggests that the existence of musculocutaneous perforator is in doubt. Two clinical cases, with a medial sural perforator flap and a lateral sural perforator flap, respectively, are presented. © 2009 Wiley‐Liss, Inc. Microsurgery, 2009.     

Suprapopliteal flap

To investigate the cutaneous artery in the popliteal region, cadaver dissections were performed on 16 lower limbs. Two types of the cutaneous vessel have been found. One is the direct cutaneous vessel from the popliteal vessels; the other is the cutaneous vessel branching from the muscular vessel to the semimembranous muscle from the popliteal vessels. In our cadaver dissections, the latter was found consistently in the 16 lower limbs. The location of the vascular pedicle is 12.5 to 24.0 cm from the tibial condyle. The newly developed suprapopliteal flap supplied by this vessel is described. We applied this flap in four clinical patients: in one as a free flap, in the others as an island flap. Three (one free, two pedicled) flaps survived completely. The upper part of a pedicled flap partially necrosed. The operative procedure and the characteristics of the suprapopliteal flap are discussed. This flap can be used as a free flap and is also a versatile way to reconstruct soft tissue defects around the knee joint.     

Free flow‐through anterolateral thigh flap for complex knee defect including the popliteal artery

Reconstruction of complex knee defects including the popliteal artery presents a challenging problem in reconstructive microsurgery. Reconstruction of the popliteal artery and soft‐tissue coverage should be performed simultaneously for limb salvage. We present the one‐stage reconstruction of a complex knee defect including the popliteal artery using a free flow‐through anterolateral thigh (ALT) flap as a bypass flap in two patients with sarcomas. In both patients, the popliteal artery and vein were reconstructed using branches of the lateral circumflex femoral arterial system. The flaps survived without vascular compromise and the limbs were preserved successfully. Free flow‐through ALT flap enables simultaneous leg revascularization and soft‐tissue coverage with a single free flap. The lateral circumflex femoral arterial system has many branches with large diameters, making it suitable for reconstruction of multiple infrapopliteal arteries. © 2015 Wiley Periodicals, Inc. Microsurgery 35:485–488, 2015.     

游离股后侧皮瓣移植修复四肢大面积皮肤缺损

本文介绍采用游离股后侧皮瓣修复大片四肢皮肤缺损12例,均获成功。作者发现该皮瓣营养血管来自腘动脉直接皮支,其直径2.5～3.5mm,于膝上6～8cm发出。皮瓣大小可取到12～24cm,并在横径小于10cm时供区可直接关闭。该皮瓣皮支恒定,直径较粗易于吻合,皮瓣供区范围较大且较隐蔽,适于四肢皮肤软组织缺损的修复。     

The lower posterolateral thigh flap

The vascular basis of a new distally based flap in the distal third of the posterolateral thigh has been studied in 30 cadaver limbs. This flap is supplied mainly by direct cutaneous branches of the popliteal artery and of the lateral superior genicular artery. Its use as a distally based fasciocutaneous flap for defects of the knee is illustrated and its potential as a free flap is discussed. A classification of various flaps from the posterolateral region of the thigh is also proposed. In the light of the anatomical studies, the cutaneous blood supply of the distal posterolateral region and other regions of the thigh is reviewed.     

Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery

A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region.Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending.The cutaneous area of the flap of the thigh’s posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers.     

腓动脉皮支逆行岛状皮瓣的解剖与应用改进

目的探讨腓动脉皮支逆行岛状皮瓣的解剖学基础及临床应用效果。方法采用新鲜及防腐尸体下肢共25肢,对腓动脉皮支进行解剖学观测。于2003年9月~2005年6月收治足跖趾关节处软组织缺损患者10例,男8例,女2例。年龄21~55岁。其中背侧6例,跖侧4例,缺损范围10cm×6cm~15cm×10cm。应用带有外踝上11.0±1.7cm腓动脉固定皮支的腓动脉皮支逆行岛状皮瓣修复,皮瓣范围11.0cm×6.5cm~16.0cm×11.0cm。供区6例直接减张缝合,4例行自体游离皮片覆盖。结果解剖学观测外踝上11.0±1.7cm自腓动脉发出一固定皮支,起始点直径1.45±0.12mm,入深筋膜点距腓肠神经营养血管皮瓣轴线15.70±1.20mm。10例患者术后皮瓣均成活,血运良好,无静脉回流障碍;供区愈合良好。术后获随访6~12个月,皮瓣外形良好,质地、色泽与周边相似,足功能恢复良好,两点辨别觉11~18mm。结论腓动脉皮支逆行岛状皮瓣经改进后血运好,逆转距离长,修复范围大,操作简便,为临床修复足中远端软组织缺损提供了一种新方法。     

腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的应用解剖

目的研究腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的分布规律及临床应用。方法对30侧动脉灌注红色乳胶成人下肢标本,解剖观测远端蒂部的动脉来源及分布。2003年1月～2004年8月,在解剖学研究的基础上,临床采用低旋转点的腓肠神经-小隐静脉营养血管远端蒂皮瓣36例。其中男21例,女15例。年龄6～66岁,平均35.2岁。足跟及足底部皮肤缺损18例,足背部缺损10例,中前足缺损8例,均伴有骨、肌腱外露。缺损范围:3.5cm×2.5cm～17.0cm×11.0cm,切取皮瓣4cm×3cm～18cm×12cm。结果远端蒂动脉穿支2～5支,来源于跟外侧动脉穿支及外踝后动脉穿支,外径0.6±0.2mm和0.8±0.2mm,距外踝尖上1.0±1.3cm和2.8±1.0cm。腓动脉肌间隔穿支0～3支,出现率依次为96.7%、66.7%和20.0%,外径0.9±0.3、1.0±0.2和0.8±0.4mm,距外踝尖上5.3±2.1、6.8±2.8和7.0±4.0cm。动脉穿支发出皮支、皮神经浅静脉营养支和深筋膜支,形成腓肠神经-小隐静脉营养血管链和深、浅筋膜血管网。临床应用36例皮瓣全部成活,仅3例术后皮瓣边缘少量坏死,经换药后愈合。所有患者经8～16个月随访,供区外形良好,患肢能正常行走,皮瓣感觉逐步恢复。结论以外踝后动脉穿支为蒂,皮瓣旋转点在外踝尖上3.0cm。以跟外侧动脉穿支为蒂,皮瓣旋转点近外踝尖平面。     

Microsurgical anatomy of the lateral skin flap of the leg

The blood supply, venous drainage, and innervation of the lateral skin flap of the leg were studied in 52 fresh specimens by dissection, angiography, and selected injection of cutaneous arteries with india ink. This flap has a long vascular pedicle that contains the peroneal artery and vein and their branches. The diameter of the peroneal artery is about 3.7 mm. There are 4 to 7 cutaneous branches that penetrate the posterior intermuscular septum and widely anastomose with each other in the subcutaneous tissue. The skin area supplied by the peroneal artery measures approximately 32 X 15 cm. There are 2 sets of veins in the flap: (1) 2 deep veins, the peroneal veins, are about 4 mm in diameter, and (2) a superficial vein, the small saphenous vein, is about 3.3 mm in diameter. The cutaneous nerve is the lateral sural cutaneous nerve. This new lateral skin flap of the leg may be used either as a free flap or as a cutaneous flap and has been proven successful clinically.