腓肠神经营养血管远端蒂皮瓣的解剖学研究

背景有关腓肠神经营养血管远端蒂皮瓣的血管分布特点缺少具体可操作性的研究.目的探讨腓肠神经营养血管皮瓣远端蒂的血管分布规律,为临床足部损伤修复的术式设计提供解剖学依据.设计单一样本研究.单位解放军南京军区福州总医院军区临床解剖学研究中心,解放军第九十七医院骨科.对象32侧经动脉灌注红色乳胶成人下肢标本(由解放军南京军区临床解剖学研究中心提供).方法解剖观测远端蒂部的血管来源和小隐静脉深交通支.主要观察指标①远端蒂腓肠神经的营养血管.②远端蒂小隐静脉的营养血管.③远端蒂小隐静脉的浅深交通支.结果远端蒂部的营养血管有2～5支来自跟外侧动脉穿支、腓动脉终末穿支外径分别为(0.6±0.2),(0.8±0.2)mm,距外踝尖上分别为(1.0±1.3),(2.8±1.0)cm;腓动脉肌间隔穿支0～3支,出现率依次为96.7%,66.7%和20.0%,外径分别为(0.9±0.3),(1.0±0.2)和(0.8±0.4)mm,距外踝尖上分别为(5.3±2.1),(6.8±2.8)和(7.0±4.0)cm.远端蒂中的小隐静脉营养血管来源有两种类型,①神经-静脉营养血管;②静脉-神经营养血管.小隐静脉浅深交通支距外踝尖上(3.4±0.9)cm,外径(1.7±0.5)mm,汇入腓静脉.结论跟外侧动脉穿支、腓动脉终末穿支及腓动脉肌间隔穿支发出深筋膜支、皮支、神经及静脉营养支,形成腓肠神经小隐静脉血管链,深、浅筋膜血管网.小隐静脉浅深交通支汇入腓静脉.

Anatomical study on sural nerve nutrient vessels of the distally based flap

BACKGROUND: There exists insufficient study with specific applicability regarding vascular distribution characteristics of sural nerve nutrient vessels of the distally based flap.OBJECTIVE: To investigate the distribution of sural nerve nutrient vessels of the distally based flap and provide an anatomical evidence for the design of operation on repair of foot injury.DESIGN: A single sample study.SETTING: Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA, and Department of Orthopaedics, the 97 Hospital of Chinese PLA.PARTICIPANTS: Thirty-two samples of lower extremities whose blood vessels were perfused with red emulsion were provided by Research Center of Clinical Anatomy, Fuzhou General Military Hospital of Nanjing Military Area Command of Chinese PLA.METHODS: The origin of the blood vessels of distally based flap and deep communicating branches of the lesser saphenous vein in the samples were dissected and observed.MAIN OUTCOME MEASURES: ①The nutrient vessels of sural nerve of distally basde flap.②The nutrient vessels of lesser saphenous vein of distally based flap.③The superficial and deep communicating branches of lesser saphenous vein of distally based flap.RESULTS: There were 2 to 5 nutrient vessels in the distally based flap:one originating from the perforating branch of the lateral calcaneal artery was (0. 6 ± 0.2) mm in diameter and one from the terminal perforating branch of the peroneal artery was(0.8±0. 2) mm in diameter and they were (1.0 ± 1.3) and(2. 8 ± 1.0) cm, respectively, away from the lateral malleolus. The incidence of intermuscular septum perforating branches (0 to 3) was 96. 7%, 66.7% and 20. 0%, respectively, and their diameter was (0.9 ±0. 3), (1.0 ±0. 2) and (0. 8 ±0. 4) mm and their distance to lateral malleolus was(5.3 ±2. 1), (6. 8 ±2.8) and (7.0 ±4.0) cm, respectively. There were 2 types of nutrient vessels of the lesser saphenous vein of distally based flap, the nutrient vessels of nerve-vein and the ones of vein-nerve. The superficial and deep communicating branches of the lesser saphenous vein were(1.7 ±0. 5) mm in diameter and(3.4 ±0. 9) cm away from the lateral malleolus. They ended at the peroneal veins.CONCLUSION: The perforating branches of heel lateral artery, the terminal perforating branches and intermuscular septum perforating branches of the peroneal artery have sub-branches to deep fascia, skin, nerves and parenteral nutrient vessels. These sub-branches communicate and form vascular chain of lesser saphenous vein to sural nerve and vascular network of superficial and deep fascia. The superficial and deep communicating branches end at the peroneal veins.