逆行岛状腓骨肌皮瓣再造足跟

目的探讨逆行岛状腓骨肌皮瓣的血供基础及足跟再造。方法应用解剖学的方法研究腓骨肌皮瓣血供及跟骨的生物力学特征，并在标本上进行摹拟手术。1998年5月为1例右足跟爆炸伤后2个月，全足跟缺损患者采用腓血管蒂逆行岛状腓骨肌皮瓣移位修复，腓骨瓣长14cm，带部分腓骨肌及(口)/(止)母长屈肌，皮瓣为14cm×12cm。结果①腓动脉下端与胫前、胫后动脉有丰富且粗大的吻合，完全可提供逆流供血；血管蒂旋转点因手术需要而定，最低点为外踝上6cm，此处血管蒂解剖可长达20cm；②该瓣的形态与跟骨的生物力学特征相适应，临床应用者术后腓骨肌皮瓣成活好，随访10个月获得满意效果。结论逆行岛状腓骨肌皮瓣可修复足跟严重缺损，尤其为跟骨及骰骨完全缺失者提供了一种新方法。

RECONSTRUCTION OF HEEL BY REVERSED ISLAND FIBULAR MUSCULOCUTANEOUS FLAP

Objective To explore the anatomical basis of blood supply and heel reconstruction by reversed island fibular musculocutaneous flap. Methods The blood supply of fibular musculocutaneous flap and the biomechanical characteristics of heel were studied by anatomical examination. One case with right heel full defect because of explosion injury was repaired by tranfer of reversed island fibular musculocutaneous pedicled fibular vessels. The fibular flap was 14 cm in length with part of peroneus muscle and long flexor muscle of great toe. Results The lower part of fibular artery had plentiful anastomosis with anterior tibial artery and posterior tibial artery, which could provide ideal reversed blood supply. The rotatory point of vessel pedicle could be choosed according to the need of operation. The lowest site might be above 6 cm to lateral malleolus, and the vessel pedicle was 20 cm in length. The morphological feature of the reversed island fibular musculocutaneous flap was suitable to the biomechanical character of heel. The patient achieved satisfactory clinical result, the musculocutaneous flap survived well for 10 months of follow up. Conclusion The reversed island fibular musculocutanecous flap provide a new method for repairing the severe heel defect, especially in full defect of calcaneus and cuboid bone.