隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学研究

目的探讨隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学结构,为临床手术提供依据。方法对30侧经动脉灌注红色乳胶的成人下肢标本进行解剖,并观察隐神经-大隐静脉营养血管的来源、分支、吻合及其与胫骨、比目鱼肌血供的关系。结果由近及远,隐神经-大隐静脉营养血管来自隐动脉3~5支,外径0.7±0.4mm;膝下内动脉皮支,外径0.7±0.2mm;胫后动脉肌间隙支2~7支,外径1.0±0.2mm,其肌支营养比目鱼肌内侧半;骨皮穿支1~2支,外径1.3±0.3mm;踝前内侧穿支,外径0.6±0.2mm;踝上穿支,外径0.8±0.3mm。各穿支穿深筋膜时,发出深筋膜支、骨膜支、皮支和神经静脉血管,构成骨膜、深筋膜和皮神经浅静脉3个层面的血管丛。结论隐神经-大隐静脉营养血管与肌、骨及皮营养血管同源,是构成隐神经-大隐静脉营养血管远端蒂复合瓣的解剖学基础。

ANATOMIC STUDY ON COMPOUND FLAP OF DISTALLY-BASED SAPHENOUS NERVE-GREAT SAPHENOUS VEIN NUTRITIONAL VESSELS

OBJECTIVE: To investigate the anatomic structure of the compound flap of distally-based saphenous nerve-great saphenous vein nutritional vessels so as to provide anatomic basis for the clinical operation. METHODS: The origin, branches, anastomosis of nutritional vessels of sural nerve-great saphenous vein, and the relation of blood supply of tibia and soleus muscle were observed on 30 low limb specimens of adult cadaver, which were perfused with red gelatin to dissect from the artery. RESULTS: The nutritional vessels of sural nerve-great saphenous vein originated from: the saphenous artery 3-5 branches with a diameter of 0.7+/-0.4 mm; the cutaneous branches of medial inferior genicular artery, diameter of 0.7+/-0.2 mm; the intermuscular space perforating branches of posterior tibial artery 2-7 branches with a diameter of 1.0+/-0.2 mm, the internus half side of the muscular branches nutrient soleus muscle; the perforating osteoseptocutaneous 1-2 branches with a diameter of 1.3+/-0.3 mm; the perforating branches of superior malleolus with a diameter of 0.6+/-0.2 mm; the perforating branches of medial anterior malleolus with a diameter of 0.8+/-0.3 mm. A vascular network of 3 layers, which included periosteum, deep artery, and fascia nerve and superficial vein, was formed by those branches of deep artery, fascia branches, periosteum branches, and nerve-vein nutrition branches. CONCLUSION: The nutritional vessels of saphenous nerve-great saphenous vein has the same origin as muscles, bones, and cutaneous nutritional vessels. It provides anatomic basis for the compound flap of distally-based saphenous nerve nutritional vessels.