小腿后部各区穿支间的关系与皮瓣设计

目的 研究小腿后部各区穿支间的关系,为穿支皮瓣的临床应用提供解剖学依据.方法 选择6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本,将小腿后部分为上、中、下三等份,层次解剖观测各区穿支的分布状况,拍摄X线片测量穿支的定位、直径、走行、分支及其相互之间的吻合状况.结果 小腿后部共有外径为0.5 mm的穿支13支,平均外径0.8 mm,平均供血面积38 cm2.上区来自腘动脉的穿支起于胭窝中部,其浅出深筋膜的位置,通常位于股骨内、外上髁之连线与小腿后正中线交点4 cm范围内,其单穿支供血面积高达55 cm2.此穿支向下与来自胫后动脉、腓动脉之穿支形成不减少口径的真性吻合:下区穿支较细,但沿跟腱两侧呈链状分布.结论 小腿后部穿支皮瓣可以移植到下肢或身体其它部位,中区可切取穿支皮瓣游离移植,上区与下区可分别切取近端蒂与远端蒂穿支皮瓣.

Relationship and flap design on the perforators of the posterior leg

Objective To study the anastomotic relationships of perforators in each zone of the poste-rior leg and design perforating flaps for clinic. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. The posterior part of leg is divided into upper, mid-die and below equal parts, Observe topography of the perforating branches in every district by layer, and mea-sured their location, diameter, course, branches and anastomosis pattern. Radiographs of tissue specimens were digitally analyzed. Results There were 13 perforators that diameter≥ 0.5 mm, the average external diameter was 0.8 mm. The areas of each perforator supplied was average 38 cm2. Perforators from popliteal artery was identified an area 4 cm wide, around the intersection of two lines, a line drawn between the medial and lateral epicondyles of the femurs, and the midline of posterior leg. The areas of the every perforator sup-plied was 55 cm2. These vessels were large in diameter and create multiple true anastomoses with the perfora-tors from the posterior tibial artery or fibular artery. Perforating branches were small in the below part, a long perforator chain comprised of two to three perforators accompanies the Achilles tendon. Conclusion The perforator flaps deviced by perforators from the posterior leg may be transplanted to the lower limbs and the other part of the body. The perforators located in the middle zone of the leg are larger. Free posterior tibial or peroneal perforator-based flaps are reliable, relatively large, and have thin flaps. The upper and lower zones were the larger donor site for the proximal or distally pedicled perforator flap harvest.