远端蒂腓浅神经营养血管肌皮瓣的解剖与临床应用

目的探讨腓浅神经营养血管为蒂的肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎的解剖学依据及其临床应用效果。方法对30侧成人下肢灌注标本进行解剖,系统观测腓浅神经及其营养血管的来源、走行、分布、吻合及外径;3侧成人新鲜下肢标本墨汁灌注,观测腓浅神经营养血管的墨染范围;在此基础上,自2009年6月以来,应用远端蒂腓浅神经营养血管肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎者12例。结果腓浅神经营养血管发自胫前动脉穿支,其血管在其神经束间及神经旁相互吻合构成丰富的血管网,并借分支与皮下筋膜血管网沟通,并与腓骨长肌、趾长伸肌的肌支有恒定的吻合,营养筋膜皮肤。12例肌皮瓣的肌肉面术中可见渗血活跃,血供良好,皮瓣均成活,术后3~6个月随访12例肌皮瓣均存活,慢性骨髓炎治愈,外形满意。结论腓浅神经营养血管的肌皮瓣转位修复小腿远端及足踝部特殊创面是较佳的选择,该肌皮瓣具有血供可靠,预后良好等优点。

Anatomy and clinical application of the composite flap pedicled with the superficial peroneal nerve and its nutrient vessels

Objective To provide anatomic basis and clinical implication of the composite flap pedicled with the superficial peroneal nerve and its nutrient vessels.Methods 30 specimens of adult cadaveric lower limb were used to observe the branches,distributions and anastomoses of the vessels and nerves in superficial layer of the posterior crural region.Since June 2007,distally based superficial peroneal nerve vascular flaps were applied for repairing 12 cases of distal leg(foot back,heel,etc.) skin and soft tissue defect followed by bone osteomyelitis. Results The nutrient vessels of superficial peroneal nerve formed the rich vascular network,and anastomosed permanently with the subcutaneous vascular network,or anastomosed with muscular branches of long peroneal muscle and EDL.2～3 anastomosing ramus could be found respectively.The medial anastomosing branches were more closed to the middle groove,with the more larger diameter than that of lateral ones.During the operation procedure,we routinely observed the errhys in the compound flap,which demonstrated the fine blood circulation in the flap.All flap survived after operation,and the recovered osteomyelitis and satisfied flap outline were obtained through the follows up(3 to 6 months).Conclusions Distally based sural neuron-myocutaneous flap offers an excellent donor site for repairing soft tissue defect of foot and ankle.