保留腓肠神经的血管筋膜蒂皮瓣的解剖及临床研究

目的 研究保留腓肠神经的腓动脉穿支皮瓣的可行性、方法 及适应证,以改进常规腓肠神经营养血管皮瓣术后足外侧皮肤感觉障碍的缺陷. 方法 选择8具16个成人下肢标本,其中新鲜标本8个,经股动、静脉分别灌注红蓝色乳胶48 h后,解剖研究腓肠神经及小隐静脉伴行动脉的关系.临床应用保留腓肠神经主干或内、外侧支的血管筋膜皮瓣修复足踝皮肤缺损12例. 结果 腓肠神经及小隐静脉有各自的伴行血管,伴行血管与腓肠神经及小隐静脉的距离不恒定,在1～8哪之间,两条伴行血管相互交通.腓动脉最低穿支距踝尖12～32 min,平均22 mm,穿支直径1.0～1.5 mm,平均1.2mm.临床保留腓肠神经主干、内侧支或外侧支的皮瓣12例.术后4例腓肠神经支配区皮肤感觉正常;4例S2+～S3;2例外踝区域S0感觉消失,2例足外侧S1.经6～24个月的随访,4例S2+～S3于术后5～30 d恢复达基本正常. 结论 保留神经对保存足部皮肤感觉有积极的意义,腓肠神经及小隐静脉各有一条伴行动脉是保留神经的解剖基础.当营养血管绕过神经,很难分离神经时,可以术中放弃保留神经.

Anatomical study and clinical application for the vascular axis fasciocutaneous flap with sural nerve preserved

Objective To explore the feasibility, method and indications of distally-based vascular fasciocutaneons island flap with sural nerve preserved for improving the sensory absence of lateral foot after traditional surgical procedures. Methods Sixteen lower limbs of 8 cadavers, 8 fresh limbs were infuse dthe red and blue latexes via femoral artery and vein. After 48 hours, anatomical study of the sural nerves and lesser saphenons veins with their axial arteries was performed. Clinically, 12 cases of the skin defects of foot and anterior tibias were repaired by vascular fascioeutanoons island flap, in which the aural nerves were dissociated and preserved from the flaps. Results There was a respective axial artery accompanying the sural nerve and the lesser saphonous vein. The distances between axial artery and nerve and vein were uncertain, range from 1-8 mm. Furthermore, the 2 axial arteries are communicated each other. The furthest perforators of sural artery were 12-32 nun from the top of lateral ankle, the average was 22 mm. The diameters of the perforator were 1.0-1.5 mm, the average were 1.2 mm. The sural nerves of all 12 cases were preserved in surgery. The skin sensation of the innervation of sural nerve was S3+- S4 in 4 cases, and S2+ - S3 in 4 cases. The sensation of lateral ankle area was So in 2 cases, and the lateral foot area was S1 in another 2 cases. After 6-24 months (mean 14 months) follow-up, 4 cases of S2-S3 recovered to normal in 5-30 d after surgery. Conclusion There is a positive value of preserving sural nerve for the foot sensation. The repective axial arteries accompanying the sural nerve and the lesser saphenons vein are the anatomic bases of preserving nerve. Be cantion of injuring the accompanying artery while surgery.