带腓肠外侧皮神经及其营养血管筋膜皮瓣的应用解剖

目的 为带腓肠外侧皮神经及其营养血管筋膜皮瓣的临床应用提供解剖学基础.方法 在32例成人下肢标本上,对腓肠外侧皮神经及其营养血管进行解剖观测.结果 腓肠外侧皮神经在腓骨头平面上方 7.1±2.4cm处起于腓总神经,分布于小腿后外侧上半或上2/3的皮肤.其营养动脉主要为:腓肠外侧皮动脉:起自腘动脉,在腓骨头平面上方5.0±1.5cm处浅出,外径为0.9±0.3mm;肌间隔筋膜皮支:起自胫后动脉和腓动脉,分别在腓骨头平面下方9.2±3.8cm和15.8±3.8cm处浅出,外径为0.7±0.3mm和0.9±0.4mm.该营养动脉除在腓肠外侧皮神经周围或其内呈链式吻合外,还发出筋膜皮支与邻位的皮动脉连接.静脉血可沿伴行静脉或小隐静脉及其属支回流至深静脉.结论 以腓肠外侧皮神经及其营养血管为蒂,可设计成顺行或逆行转位筋膜皮瓣,修复邻近部位的软组织缺损.

Applied anatomy of the fasciocutaneous flap pedicled the lateral sural cutaneous nerve and its nutrient vessels

Objective To provide anatomic basis for the apply of fasciocutaneous flap based on the lateral sural cutaneous nerve and its nutrient vessels. Methods The observation and measurement of lateral sural cutaneous nerve and its nutrient vessels in postolateral leg and blood supplies of its adjacent skin were made on 32 adult cadaver lower limb specimens. Results The lateral sural cutaneous nerve comes frome the common peroneal nerve at 7.1 ±2. 4cm above the fibular head and distributes the skin at superior half or 2/3 of the postolateral leg. The blood supply of the lateral sural cutaneous nerves arises from latcral sural cutaneous artery and intermuscular septum cutaneous arteries. The former comes from popliteal artery 5.0±1. 5cm above the level of the fibular head and has a diameter of 0.9 ±0. 3mm at its origin, the latter origins respectively from the posterior tibial artery and peroneal artery which perforate separately to the superficial fascia at 9.2 ±3.8cm and 15.8 ±3.8cm below the fibular head, and their diameters are resepectively 0.7±0.3mm and0.9±0.4mm at each point of the origin. A broad artery network in the skin,subcutaneous and fascia around the lateral sural nerves were anastomosed by their cutaneous branches and the neural neutrient ones each other. The vein drainage are provided by venae comitantes accompanying nutrient arteries and the tributaries of small saphe-nous vein. Conclusion The postolateral region of leg, with a constant neurovascular pedicle,could be designed as a transfer(direct or adverse) fasciocutaneous flap which be used for repairring the soft tissue defects of the adjacent sites of knee jojnt.