腓骨头复合瓣重建内踝的临床研究

[目的]探索内踝骨与软组织缺损修复与重建的新方法。[方法]根据内踝部骨与复合软组织的缺损面积，设计以胫前动脉返支为蒂的腓骨头肌腱骨瓣，移植重建内踝和三角韧带，并组合游离移植背阔肌皮瓣修复内踝创面，临床应用7例，均为男性，分别因机器、车祸、猎枪弹伤。骨及软组织缺损，创面最小19cm×12cm，最大24cm×12cm。[结果]6例患者创面Ⅰ期愈合，1例创面感染，经抗感染换药6个月愈合。术后随访6个月～6年，平均3年，移植骨及皮瓣愈合良好，踝关节稳定，关节活动正常，内踝部外形好，效果满意。[结论]腓骨头复合瓣移植重建内踝是修复内踝缺损的好方法。     

儿童内踝外伤性缺损的修复重建

目的 探讨以带血管蒂腓骨头骨骺复合组织瓣修复重建儿童内踝外伤性缺损的手术方法 及临床效果. 方法 2003年7月-2007年12月,收治8例车轮绞伤导致内踝Peterson Ⅵ型骨骺损伤患儿.男5例,女3例:年龄2～10岁.左侧5例,右侧3例.内踝完全缺如,均伴内踝周围皮肤缺损,范围4.0 cm×2.0 cm～9.5 cm×5.5 cm.受伤至入院时间为6～8 h 2例,24～168 h 6例.术中设计腓骨头骨骺复合组织瓣一期修复内踝及其周围软组织缺损.切取皮瓣4.5 cm×2.5cm～10.0 cm×6.0 cm,截取腓骨头骨骺长度2.5～3.0 cm.供区直接缝合. 结果 术后伤口均I期愈合,复合组织瓣全部成活,无血运障碍;供区愈合良好.患儿均获随访,随访时间1～5年.内踝骨骺6～9周愈合.皮瓣色泽及弹性较好,无瘢痕挛缩.无踝关节内翻畸形发生,负重及行走满意.6例踝关节屈伸正常;2例轻度受限,背屈18～20°,跖屈35.距骨无内移,踝关节无过度外翻.按美国矫形足髁协会足踝功能评判标准,优7例,良1例.内踝骨骺无早闭发生,骨化中心逐渐明显或增大,发育与对侧基本保持同步.供区膝关节屈伸活动度正常,无内翻不稳定. 结论 腓骨头骨骺复合组织瓣可一期修复儿童内踝骨骺及周围软组织缺损,重建的内踝可随儿童的生长同步发育,是重建儿童内踝外伤性缺损的理想方法 之一.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

目的 为带血管蒂腓骨头骨骺截骨整形重建内踝提供解剖学依据,并探讨其临床应用效果.方法 20侧2～12岁新鲜儿童下肢标本,对腓骨头及内踝进行形态学测量,根据测量数据推导截骨公式.临床急诊或延期手术,移植截骨改良的腓骨头骨骺复合组织瓣一期修复内踝缺损,随访观察临床效果.结果 腓骨头倾斜角(M)为(170±8)°,关节面内倾角(N)为(145±6)°,纵长为(1.5±0.2)cm,横宽为(1.4±0.2)cm;内踝内翻角(L)为(152±8)°,关节面纵长为(1.25±0.2)cm,横宽为(1.25±0.2)cm.设内踝缺损面与胫骨纵轴的夹角为(Q),截骨角度X=L-N-Q,顶点位于腓骨头倒置后的关节面上1/6处.临床应用6例,全部一期愈合,随访1～3年,内踝发育良好,未发生骺早闭,无内翻畸形,踝关节负重、行走功能正常.结论 儿童腓骨头骨骺与内踝形态有一定的差异,通过截骨可获得满意的供体,同时携带皮瓣可一期修复内踝骨骺及周围软组织缺损并同步发育,是重建儿童内踝创伤性缺损的理想方法.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

带血管蒂腓骨头骨骺截骨整形重建内踝的应用解剖与临床应用

Objective To provide an anatomical basis for repairing the medial malleolus with bone-severed vascularized fibular head epiphysis, and to explore the effect of clinical application with this method. Methods Figures of fibular head and medial malleolus were measured on 20 fresh lower limbs specimens of child age from 2 to 12 years old, then bone-severed formula was deduced. The bone-severed composite fibular head epiphysis to repair the defect of medial malleolus were carried for 6 child patients of emergency or post-poned cases on one stage. Obersved the clinical effect by following-up. Results The angle between fibular head and stem (M) was(170±8)°, angle of fibular head sadacc(N) was (145 ±6)°, length(1.5±0.2)cm and width (1.4±0.2)cm; angle between medial malleolus and stem(1) was(152±8)°, length of the articular surface of medial malholus was(1.25 ± 0.2)cm and width (1.25 ± 0.2)cm. Angle between defect surface and tibia was(Q). Formula: angle of bone-severing X = L-N-Q, and apex at the upper 1/6 of the reversed articular surface of fibular. 6 cases with this method was completed, all healed at stage one, following-up 1 to 3 years, medial malleolos developed well and no epiphysis ossification anticipation, and the ankle joint has no inversion with its loadind and walking function good. Conclusion The fibular head epiphysis and the medial malleolus differ in shape to some extent, but good donor can be got by bone-severing, can repair the epiphysis and soft tissue defect of the medial malleolus at one stage with additional flap, developing with the child at the same time, it is a perfect method to reconstruct the traumatic defect of child medial malleohs.     

吻合血管的腓骨头联合皮瓣移植修复复杂外踝缺损

目的 总结吻合血管的腓骨头联合皮瓣移植修复复杂外踝缺损的术式及临床效果. 方法 2000年7月-2006年4月,收治6例外踝缺损患者.男5例,女1例;年龄9～47岁.车祸伤4例,砸伤2例.左侧5例,有侧1例.外踝骨缺损长度为3.5～8.5 cm;皮肤缺损范围为14 cm×4 cm～18 cm×7 cm.损伤至手术时间为15～30 d.术中采用长度为5～10 cm的吻合膝下外侧动脉腓骨头,联合大小为16 cm×5 cm～20 cm×8 cm的腓动脉穿支皮瓣或背阔肌皮瓣修复复杂外踝缺损.供区创面中厚皮片植皮加压打包. 结果 术后1周1例皮瓣远端1 cm发生干性坏死,经换药后愈合;余皮瓣均顺利成活,切口Ⅰ期愈合.供区植皮成活,切口Ⅰ期愈合.6例患者均获随访,随访时间4～15个月.移植腓骨头成活良好,8～16周均达骨性愈合.外踝外形近似正常,踝关节活动自如.移植皮瓣质地柔软,无磨损及溃烂.根据Baird-Jackson评分系统评价疗效:优3例,良2例,可1例,优良率达83.3%. 结论 吻合膝下外侧动脉的腓骨头血供良好,再造外踝外形近似正常;腓动脉穿支皮瓣及背阔肌皮瓣血供可靠,皮瓣面积大,与吻合血管的腓骨头联合移植是修复复杂外踝缺损的一种有效方法.     

吻合血管的跖骨头移植替代月骨的应用解剖

目的:探讨吻合血管的跖骨头移植替代月骨在解剖学上的可行性,寻找治疗Ⅲ期月骨无菌性坏死新的方法。方法:选用正常成人截肢手、足标本各10侧,尸体标本各10侧,用游标卡尺测量跖骨头及月骨的各径,并测量跖骨头关节面及月骨近侧关节面的曲率半径,观察其形状并做比较。结果:跖骨头的各径与月骨的各径基本相同,跖骨头关节面的曲率半径(第二跖骨头为13.6±0.7 mm,第三跖骨头为12.9±0.8mm)与月骨近侧关节面的曲率半径(13.1±0.4mm)极为接近。结论:吻合血管的跖骨头移植替代月骨治疗Ⅲ期月骨无菌性坏死在解剖学上是可行的。     

带旋髂浅血管蒂腹股沟骨皮瓣移位修复手部骨皮肤缺损

目的探讨带旋髂浅血管蒂髂腹股沟骨皮瓣移位修复手部复合组织缺损的疗效。方法1998年2月~2004年5月,收治急诊入院的33例手部皮肤软组织缺损合并骨缺损。其中男22例,女11例。年龄19~54岁,平均24.3岁。手掌贯穿伤17例,手背部电刨伤9例,其他损伤7例。其中合并掌骨缺损23例,指骨缺损10例。皮肤缺损范围3.5cm×2.0cm~15.0cm×10.0cm;骨缺损1.5~4.2cm。清创3~7d后应用以旋髂浅动、静脉为皮瓣轴型血管蒂的骨(骨膜蒂)皮瓣进行修复,皮瓣切取范围4.0cm×2.5cm~17.0cm×11.0cm。结果术后骨皮瓣全部成活,创面期愈合31例,期愈合2例。随访4~22个月,平均8.2个月,皮瓣质地良好,外观及功能满意。骨缺损达临床愈合时间5~9周,平均7周。结论带旋髂浅血管蒂髂腹股沟骨皮瓣切取简便、血供丰富,供区隐蔽,且均能直接缝合,是修复手部复合组织缺损的一种较理想的方法。     

腓骨骨皮瓣移植修复肢体复合组织缺损

目的总结腓骨骨皮瓣移植修复肢体外伤性复合组织缺损的临床修复效果。方法依照患者肢体复合组织缺失情况及全身状况,采用腓骨骨皮瓣移植进行修复,其中男9例,女3例。年龄12～45岁。胫骨缺损伴腓骨骨折2例,单纯胫骨缺损2例,桡骨缺损2例,尺骨缺损3例,跟骨缺损1例,第1跖骨缺损2例;骨缺损长度4.2～10.6cm,平均7.8cm;皮肤缺损10.0cm×4.5cm～27.0cm×15.0cm。合并胫前和(或)胫后动脉损伤2例,胫后神经损伤2例,腓总神经损伤1例。一期修复4例,延期修复8例。骨皮瓣游离移植手术9例,推移手术2例,逆行移位手术1例。4例于术后3～6个月行二期肌腱移位动力重建术。行腕、踝关节融合术各1例。结果术后出现静脉危象及腓总神经牵拉性损伤各1例,经探查、大隐静脉移植等对症治疗,12例骨皮瓣全部成活。术后随访6～24个月,移植腓骨与受区断端均达骨性愈合,肢体功能均得到良好恢复。供区未出现膝及踝关节运动障碍。结论采用急诊或延期的腓骨骨皮瓣移植手术,可较好地修复肢体长管状骨干和软组织复合组织缺损。应注意受区移植腓骨皮瓣术后的感觉功能重建。     

上唇动脉蒂逆行鼻唇沟岛状皮瓣的应用解剖

为了探索应用上唇动脉为蒂的逆行鼻唇沟皮瓣的可能性，采用８例成人尸体标本，进行显微解剖，观察上唇动脉的走行与鼻唇沟区皮肤血供的关系。结果，上唇动脉由面动脉在口角外约１０ｍｍ处由鼻翼外侧连线下２／３发出，上唇动脉出现率１００％，起始处外径（０．８±０．１）ｍｍ，主干长达９０ｍｍ。双侧上唇动脉在中线相互交通形成弓形动脉，该动脉走行于距红唇缘深面约６ｍｍ的粘膜下组织内，动脉有恒定的伴行静脉。在一侧上唇动脉起始处切断同侧面动脉近心端，可由对侧面动脉通过上唇动脉供应鼻唇沟区域血运。为临床应用上唇动脉为蒂的逆行鼻唇沟岛状皮瓣，提供了解剖学依据     

胸锁乳突肌单蒂肌皮瓣修复颌面部软组织缺陷畸形的初步报告

目的探讨胸锁乳突肌胸骨头单蒂肌皮瓣修复颌面部软组织缺损畸形的方法及效果。方法2004年5月-2006年9月,应用胸锁乳突肌胸骨头单蒂肌皮瓣修复颌面部软组织瘢痕及缺损5例,均为男性,年龄23-34岁。分别为胎儿时母亲宫腔内注射药物、婴幼儿期面颊部感染、电击伤后遗留瘢痕或凹陷畸形。需要修复范围为5cm×3cm-9cm×6cm。结果术后5例移位胸骨头肌皮瓣均成活,但因静脉回流障碍均发生小面积的表皮坏死,2-3周自行愈合,皮瓣周围有少许瘢痕形成。1例术后患侧发生肩部上抬无力,6个月后基本恢复。术后均获随访1-6个月,修复后的颌面1例蒂部略显臃肿;1例瘢痕明显,但患者满意;余3例外观满意。结论胸锁乳突肌胸骨头单蒂肌皮瓣较全胸锁乳突肌皮瓣设计更灵活,且能提供足够的组织量,是修复颌面部皮肤软组织缺损的一种理想材料。     

胸廓内动脉前穿支岛状瓣修复面颈部创面

目的：针对面颈部烧伤常系及前胸无法运用局部皮瓣转移术,而另作选择修复创面。方法：依胸三角区解剖特点结合临床经验,采用胸廓内动脉第二、三前穿支岛状辩转移结合辞下滴注bFGF进行修复治疗21例。结果：18例全部成活,面颈部修复效果良好,2例部分坏死,1例全部坏死。结论：采用胸廓内动脉前穿支岛状辩修复面颈部创伤,减少了前胸部瘢痕对皮瓣选择的限制;bFGF促进血管新生,改善创面微循环,提高了皮瓣成活率。     

大隐静脉-隐神经营养血管皮瓣的临床解剖与应用

目的探索大隐静脉-隐神经营养血管皮瓣游离移植与移位修复的临床解剖与应用.方法选取福尔马林常规固定的成人下肢标本20侧,自愿捐献新鲜成人下肢标本8侧;其中左下肢12侧,右下肢16侧.解剖20侧成人下肢标本,观察大隐静脉、隐神经及其营养血管的起源、大小、分支、分布和吻合;4侧新鲜成人下肢标本股动脉灌注朱砂滤过液,静脉灌注泛影葡胺后,钼靶X线片显示静脉周围血管网分布;另4侧新鲜成人下肢标本行大隐静脉显微解剖,观察静脉周围血管分布及吻合情况.临床应用大隐静脉-隐神经营养血管皮瓣游离修复虎口、带蒂逆行皮瓣修复足跟部及小腿下段、顺行皮瓣修复胫前及膝关节周围创面18例,其中男12例,女6例.年龄7～53岁.车祸伤7例,碾压伤4例,炸伤1例,中厚皮术后瘢痕2例,足底肿瘤扩大切除1例,外伤术后长期溃疡3例.创面部位:虎口1例,小腿上段及膝关节周围3例,小腿下段及足部14例.其中骨质外露7例,肌腱外露3例,钢板外露1例.创面范围:4 cm×4 cm～13 cm×7 cm.皮瓣切取范围6 cm×4 cm～15 cm×8 cm,蒂长8～11 cm,筋膜蒂宽2.5～4.0 cm,蒂部带窄条皮肤宽1～2 cm.结果膝降动脉在股骨内侧髁上9.33±0.81 cm处发出,分出隐动脉支伴隐神经下行,在股骨内侧髁下平均7.21±0.82 cm浅出,位于大隐静脉旁,隐动脉与胫后动脉穿支成"Y"或"T"形吻合,接力构成纵行血管链,达内踝前下方,形成皮瓣的轴心血管.大隐静脉周围5～8 mm内分布有波浪状小血管,直径约0.05～0.10 mm,也吻合成纵行链状,钼靶X线片示小血管沿静脉一侧或双侧呈平行波浪状走行.临床应用18例,术后皮瓣均成活, 2例远端3 cm出现小水泡,经拆线减张、换药后愈合.13例经6～12个月随访,修复后创面获得保护性感觉,功能接近正常,外观满意,无溃疡.结论隐神经及大隐静脉周围均有血管网伴行,大隐静脉-隐神经营养血管皮瓣可游离移植,也可形成近端蒂或远端蒂皮瓣移位修复小腿近侧或足踝部创面.皮瓣血运可靠,不牺牲主要血管,是下肢创面修复的良好供区.     

腓骨复合瓣游离移植修复下颌骨缺损

目的　总结应用游离腓骨复合瓣修复下颌骨缺损的经验。方法　 1999年 6月～ 2 0 0 0年 11月对5 8例应用腓骨复合瓣游离移植修复下颌骨缺损的病例作回顾性研究 ,其中男 37例 ,女 2 1例。年龄 12～ 6 5岁 ,平均4 0 .9岁。分析下颌骨缺损原因 ,分析腓骨瓣设计、受区血管、组织瓣成活情况及术后并发症的发生情况。结果　 5 8例中 5 2例为肿瘤切除术后修复 ,其中 4 3例为一期修复 ,9例为二期修复。采用游离腓骨复合骨瓣的腓骨长度 4～2 1cm ,平均 11.4 cm ;腓骨的截骨为 1～ 4次数 ,平均 2 .1次 ;骨瓣带皮岛最大范围 12 cm× 8cm,最小 3.0 cm×1.5 cm。术后游离腓骨瓣的临床成功率为 96 .6 % (5 6 /5 8) ,失败 2例。受供区并发症主要为血肿、积液、创口感染和腺瘘 ,有 4例为植皮坏死和创口感染 ,发生率为 2 4 .1% ,但不影响效果。结论　游离腓骨瓣在修复下颌骨缺损中具有操作灵活 ,安全可靠 ,制备简便 ,并发症少 ,可以满足各种类型下颌骨缺损修复的需要     

带前臂外侧皮神经营养血管筋膜皮瓣的应用解剖

目的：为带前臂外侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法：在３２侧成人上肢标本上，观测前臂外侧皮神经营养血管及其周围皮肤的供血情况。结果：前臂外侧皮神经近侧的血供为肱动脉末端和桡动脉起始部的肌皮支，起始处外径分别为１．４ｍｍ、１．１ｍｍ，穿出深筋膜前长为１．９ｃｍ、１．４ｃｍ；远侧主要为桡动脉的粗大皮支，起始处外径为０．８ｍｍ，穿出深筋膜前长０．８ｃｍ；此外，桡动脉的茎突返支及掌浅支的皮支营养其远端。其神经支在神经束间或神经旁相互吻合构成纵向（链式）血管网，并借分支与筋膜皮支所形成的皮下筋膜血管网沟通。结论：可设计带前臂外侧皮神经及其营养血管的筋膜皮瓣，顺行或逆行转位修复邻近部位的软组织缺损。