带皮穿支血管的皮神经营养血管皮瓣的临床应用

目的探讨带皮穿支血管与皮神经营养血管相结合的皮瓣手术方法及临床应用效果。方法以深部知名血管发出的皮肤穿支为皮瓣转轴点,切取皮神经营养血管带蒂皮瓣或岛状皮瓣,转位修复肢体远端皮肤软组织缺损创面。结果临床已应用43例,其中腓动脉穿支腓肠神经营养血管皮瓣13例,面积30 cm×12 cm~16 cm×8 cm;胫后血管穿支隐神经营养血管皮瓣9例,面积17 cm×9 cm~5 cm×4 cm;以骨间前血管腕背穿支前臂背侧皮神经营养血管皮瓣8例,面积16 cm×6 cm~10 cm×4 cm;以掌指动脉指蹼穿支手背皮神经营养血管逆行皮瓣13例,皮瓣面积6.0 cm×3.5 cm~2.5 cm×1.5 cm;皮瓣完全成活42例,1例因静脉回流障碍远端1/4坏死。随访6~24个月,皮瓣质地优良,外形与功能恢复满意。结论该术式结合了穿支蒂皮瓣与皮神经营养血管皮瓣的优点,扩大了皮瓣切取面积与修复范围,皮瓣设计灵活,切取方便,血供可靠,是修复肢体皮肤软组织缺损的一种可取的方法。

Clinical applications of the neurocutaneous axial flap pedicled with perforating vessels

OBJECTIVE: To report the operative technique and clinical results of the neurocutaneous vascular axial flap with perforating vessels as its pedicle. METHODS: An axial skin flap was designed along the axis of small paraneural vessels that was close to a concomitant cutaneous nerve. The cutaneous perforating branches of major arteries were used as the pedicle, which provided a rotation arc for the flap to cover the defects in the distal site of extremities. 43 neurocutaneous vascular axial flaps were transferred, including 13 sural neurocutaneous axial flaps (30 cm x 12 cm to 16 cm x 8 cm) supplied by perforating branches of the peroneal vessel; 9 saphenous neurocutaneous axial flaps (15 cm x 8 cm to 5 cm x 4 cm) with posterior tibial perforators as the pedicle; 8 posterior antebrachial neurocutaneous axial flaps (16 cm x 6 cm to 10 cm x 4 cm) based on the dorsal branch of the anterior interossea vessel and 13 reversed neurocutaneous axial flaps (6.0 cm x 3.5 cm to 2.5 cm x 1.5 cm) on the dorsal hand pedicled with the perforators at the interdigital web space. RESULTS: 42 flaps survived completely. One flap underwent venous congestion with necrosis on the distal one fourth of the flap. The color and texture of the flaps were good. The appearance and functional results were satisfactory as revealed by follow-up for 6 to 24 months. CONCLUSIONS: The modified operation combines the advantages of both the perforator flap and the neurocutaneous axial flap, enlarges the size of the flap and extends the scope of reconstruction. The flap is characterized with delicate designation, easy dissection and reliable blood supply. It is a good method in repairing the skin defects of the extremities.