吻合腓肠内侧血管穿支皮瓣的应用解剖和临床应用

目的 报道腓肠内侧血管穿支皮瓣的解剖学研究与游离移植的临床效果.方法 用明胶-氧化铅液灌注12侧标本的胭动脉,观测腓肠内侧血管及其穿支的分支、蒂长、管径等;取下标本皮肤软组织拍摄X线片,利用Photoshop与Scion Image分析穿支分布的趋向性和供血面积.临床上吻合腓肠内侧血管穿支皮瓣修复5例手部软组织缺损,皮瓣面积为7 cm×4 cm～12 cm×8 cm. 结果 所有标本的腓肠内侧血管至少存在1支穿支,平均2.1支;位于距横纹9～18 cm、距后中线1～5 cm的范围内;其深筋膜处的外径为(1.03±0.22)mm;穿支供血的总面积为(107.5±23.9)cm2,单穿支的供血面积为(58.3±17.0)cm2.5例移植皮瓣全部成活,随访6～12个月,手部修复后外形与功能恢复满意.结论 明胶-氧化铅液灌注造影是皮瓣血管解剖学研究的可靠方法;腓肠内侧血管恒定存在的穿支,可作为腓肠内侧血管穿支皮瓣的血供来源;该皮瓣外形美观,是修复手部中、小面积皮肤软组织缺损的良好选择.

Anatomical study and clinical application of the medial sural artery perforator flap

Objective To report the anatomical study and clinical application of the medial sural artery pertorator flaps. Methods The anatomical study involved 12 fresh adult cadaver lower legs, the arteries of which were perfused with suspensions of lead oxide and gelatine. The bifurcation, location, length, diameter and blood territories of the medial sural artery and its perforating vessels were recorded by dissection, angiography and photography. The integument of the leg was dissected and ridiographed. The tendency of the vessels was analyzed, the surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. With the aid of anatomic study, a series of five clinical cases was reported, including five free medial sural flaps for ipsilateral hand reconstruction. Results There was at least one perforating vessel in the medial sural areas of the specimen. A mean of 2.1 perforators was noted over the medial gastrocnemius muscle. The perforating vessels from the medial sural artery clustered about 9 to 18 cm from the popliteal crease, 1 to 5 cm from the posterior medial line. Their diameter was (1.03±0.22)mm at the deep fascial level. The average vascular territory on the sural area was (107.5±23.9)cm2, and the average supplying area of single perforator was (58.3±17.0)cm2. All the transferred free flaps taken in the 5 clinical cases survived uneventfully. All the patients were followed-up from 6 months to 12 months. The appearance of flaps and the function of the limbs were satisfied. Conclusion The standard method for the study of perforator flap is the lead oxide-gelatin technique. It is the anatomic basis that there are perforating musculocutaneous vessels on the medial gastrocnemius muscles constantly. The free medial sural perforator flap has the advantage of good appearance. It is the safe and suitable choice in the cases when a medium or small-sized flap is required for resurfacing hand injuries.