小腿外侧腓动脉皮支皮瓣的解剖与临床应用

目的研究以腓动脉皮支血管为蒂的小腿外侧皮瓣吻合血管游离移植的解剖学与临床应用。方法解剖20具40侧成人尸体小腿,测量小腿外侧腓动脉皮支的有关数据。多普勒血管仪测定30侧成人活体小腿外侧腓动脉皮支血管穿出点。临床行21例小腿外侧腓动脉皮支皮瓣吻合血管的游离移植手术。结果40侧小腿共观察到皮支140支,每侧1~7支不等,平均3.5支,其中一侧只有1支高位皮支。皮支的穿出点大多(76%)在腓骨头最凸点下方7~21 cm范围。每侧最粗的皮支动脉外径平均为(1.8±0.4)mm(1.4~2.9 mm),两条伴行静脉外径平均(3.0±0.5)mm和(2.4±0.4)mm。30侧活体小腿共测到小腿外侧皮支血管穿出点145个,平均每侧4.8个。临床切取皮瓣大小5.0 cm×3.5 cm~28 cm×11 cm,21块皮瓣均成活。结论小腿外侧皮瓣由不同数目的腓动脉皮支供养,其主皮支能满足显微外科吻合血管的要求。以皮支血管为蒂的小腿外侧游离皮瓣移植,比以腓血管为蒂创伤小、操作简单、血运重建符合生理。

The lateral crural flap nourished by cutaneous branches of peroneal artery: an anatomic and clinical study

OBJECTIVE: To study the anatomy of lateral crural skin flap nourished by cutaneous branches of peroneal artery and its clinical application as vascularized skin flap transfer. METHODS: In 20 cadavers specimen with 40 lower limbs, the cutaneous branches of the peroneal artery were dissected and their measurements were recorded. In the other 30 adult legs, their perforating points of the cutaneous arteries of peroneal artery were detected with supersonic Doppler flow meter. With the aid of anatomic and supersonic Doppler flow meter study, vascularized transfer of lateral crural skin flap pedicled by cutaneous branches of peroneal artery were successfully performed in 21 clinical cases. RESULTS: In altogether 40 legs studied, 140 cutaneous branches were found. One to seven branches were found on one specimen, the average was 3.5 branches, in one leg was a high perforating skin branch. The perforating points of the cutaneous branches were mostly (76% cases) appeared within 7 - 21 cm length below the protruding point of head of fibula. The external diameter of the thickest cutaneous branch of each leg was (1 .4 - 2.9) mm, (1.8 +/- 0.4) mm, while the external diameters of two vena concomitants were (3.0 +/- 0.5) mm and (2.4 +/- 0.4) mm. 145 artery perforating points in 30 legs were detected by Doppler, with an average points of 4.8. The skin flaps taken in the 21 clinical cases were 5.0 cm x 3.5 cm - 28 cm x 11 cm in size. All the transferred free flaps survived uneventfully. CONCLUSIONS: The lateral crural skin flap is nourished by a variable number of cutaneous branches of peroneal artery. The main branch can meet the demand of microvascular anastomosis. The free transfer of lateral crural flap by anastomosis of cutaneous branch of peroneal artery is superior to lateral skin flap transfer by anastomosis of main trunk of peroneal artery with the merit of simple procedure, minimal trauma and more physiological circulation established.