逆行腓肠神经营养血管岛状皮瓣感觉重建的解剖研究

目的研究应用股后皮神经主干重建逆行腓肠神经营养血管岛状皮瓣感觉功能的解剖学依据. 方法 30只成人尸体下肢标本,4%甲醛固定,手术放大镜下解剖股后皮神经主干于小腿后部的分布、分支及其与小隐静脉的关系,记录直径0.1 mm以上的神经分支,测量其长度及直径. 结果在小腿后窝处,股后皮神经主干下行进入浅筋膜,与小隐静脉伴行,70%位于小隐静脉内侧,30%位于小隐静脉外侧.股后皮神经主干全程有营养血管伴行.根据神经的分布范围,将股后皮神经分为3型:Ⅰ型,分布于小腿后部上1/4,占33.3%,神经干于窝中点直径为0.5±0.1 mm;Ⅱ型,分布于小腿后部上1/2,占43.3%,神经主干于窝中点的直径为1.0±0.4 mm,在小腿后部中上段(即:逆行腓肠神经营养血管岛状皮瓣的常用供区)发出分支2.0±0.8支,分支直径0.3±0.2 mm,分支长度3.5±2.7 mm,分支末端与小隐静脉之间的距离为0.8±0.6 mm;Ⅲ型,分布于小腿后部上3/4,占23.3%,神经主干于窝中点的直径为1.2±0.3 mm,在小腿后部中上段发出3.7±1.7支分支,分支直径0.4±0.1 mm,分支长度3.7±2.6 mm,分支末端与小隐静脉之间的距离为0.8±0.4 mm.在小腿后部中上段,未发现腓肠内侧皮神经发出分支进入浅筋膜. 结论通过股后皮神经主干与受区感觉神经分支吻合,股后皮神经(66.6%,Ⅱ型与Ⅲ型)可以用于重建逆行腓肠神经营养血管岛状皮瓣的感觉功能.

ANATOMICAL STUDY ON RESTORATION OF THE SENSATION OF DISTAL BASED SURAL ISLAND FLAP

OBJECTIVE: To investigate the anatomic foundation of using main branch of posterior femoral nerve to restore the sensation function of distal based sural island flap. METHODS: Thirty cases of adult human cadaver legs fixed by 4% formaldehyde were used. Anatomical investigation of the posterior femoral nerves of lower legs was conducted under surgical microscope to observe their distribution, branches and their relationship with small saphenous vein. Nerve branches with diameter more than 0.1 mm were dissected and accounted during observation. The length and diameter of the nerves were measured. RESULTS: The main branch of posterior femoral nerve ran downwards from popliteal fossa within superficial fascia along with small saphenous vein. 70% of the main branch of the posterior femoral nerves lay medially to small saphenous vein, and 30% laterally. They were classified into 3 types according to their distribution in lower legs: type I (33.3%) innervated the upper 1/4 region of lower leg (region I), type II (43.3%) had branches in upper 1/2 region (region I and II), and type III (23.3%) distributed over the upper 3/4 region (region I , II and III). In type II, the diameter of the main branches of posterior femoral nerves in the middle of popliteal tossa was 1.0 +/- 0.4 mm and innervated the posterior upper-middle region (which was the ordirary donor region of distal based sural island flaps) of lower legs with 2.0 +/- 0.8 branches, whose diameter was 0.3 +/- 0.2 mm and length was 3.5 +/- 2.7 mm. The distance between the end of these branches and small saphenous vein was 0.8 +/- 0.6 mm. In type III, their diameter was 1.2 +/- 0.3 mm and innervated the posterior upper-middle region of lower legs with 3.7 +/- 1.7 branches, whose diameter was 0.4 +/- 0.1 mm and length was 3.7 +/- 2.6 mm. The distance between the end of these branches and small saphenous vein was 0.8 +/- 0.4 mm. CONCLUSION: 66.6% of human main branch of posterior femoral nerves (type II and type III) can be used to restore the sensation of distal based sural island flap through anastomosis with sensor nerve stump of foot during operation.