跨区供血腓动脉外踝上穿支蒂腓浅神经营养血管皮瓣修复足前部缺损

目的 探讨改良腓浅神经营养血管皮瓣修复足前部缺损的手术方法及临床效果.方法 对足前部皮肤软组织缺损创面,设计切取以外踝上穿支或其降支为蒂,经其升支、胫前动脉皮穿支及腓浅动脉跨区供血的腓浅神经营养血管皮瓣修复.结果 2005年2月至2008年2月,于临床应用17例,最远修复至第2、3趾基底部及第5跖骨头负重区,最大切取面积20 cm×8 cm;皮瓣均全部成活,术后随访6～12个月,皮瓣质地优良,外形与足踝功能恢复满意.结论 该皮瓣神经血管丛粗大而丰富,蒂部供血确切,旋转修复距离可达足趾,适用于涉及足前部的足背中、大面积皮肤软组织缺损的修复.

Modified superficial peroneal neurocutaneous flap pedicled with lateral supramalleolar artery arising from peroneal artery for forefoot defect

Objective To report the operative techniques and clinical results of modified distally based superficial peroneal neuroeutaneous flap for skin defect of the forefoot. Methods A reversed superficial peroneal nerocutaneous flap pedicled with the lateral superamalleolar perforating artery or its descending branch, which vascularized the flap through the nutrient vessel chain of the nerve, which linked vascular territories of superamalleolar perforating artery, cutaneous branches of the anterior tibial artery and superficial peroneal artery, was designed to repair skin defects in the forefoot. Results The modified flaps were applied in 17 cases. All flaps were survived successfully with no complication. The largest size of the flap was 20 cm × 8 cm. The flap could reach as far as the proximal end of the second and third toes or weight-bearing areas under the fifth metatarsal caput. Conclusions The modified flap has reliable blood supply with a relatively large size and long rotation are. It is a simple and safe for covering medium to large defects in the forefoot.