逆行及顺行腓肠神经营养血管皮瓣的临床应用

目的探讨腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部组织缺损，顺行转移修复膝部组织缺损的临床应用效果。方法在应用解剖及对成人小腿和足背长度测量基础上，设计带筋膜蒂的腓肠神经营养血管岛状皮瓣，逆行应用修复足背、足跟、足底及踝部软组织缺损，顺行应用修复膝部软组织的缺损。同时观察皮瓣的可切取范围、血液供应及静脉回流情况、营养血管在外踝上与腓动脉穿通支的位置及血管蒂隧道的处理方案。结果临床应用23例，其中修复足背组织缺损11例、足跟软组织缺损5例、膝软组织缺损3例、足底软组织缺损1例及外踝及足背联合缺损3例。皮瓣最大面积16cm×10cm，全部成活。结论腓肠神经营养血管皮瓣血液循环丰富，成活率高，是修复足背、足跟、踝部、足底及膝部软组织缺损的理想皮瓣。

Clinical study of sural neurovascular flap for repairing tissue defect proximally or distally

Objective To explore the clinical application of sural neurovascular flap to be transfered distally for repairing tissue defect around the heel, foot dorsum and proximally for knee. Methods On the basis of applied anatomy and length measure of adult leg and foot dorsum, the distally based sural neurovascular fascial island flap, according available flap scope, the blood supply and venous return of flap and the position of supply vessel from peroneal artery on external malleous, was designed for repairing tissue defect of knee proximally and foot dorsum, heel, sole, malleous, etc distally. Results The flap was used in total 23 cases with a maximum size of 16 cm× 10 cm including 11cases for foot dorsum defect (defect to anterior 1/3 part of foot in 8 cases), 5 cases for heel soft tissue,3 cases for knee soft tissue, 1 case for sole soft tissue, and 3 cases for outer malleolus and foot dorsum along. And all flaps survived completely. Conclusions The sural neurovascular flap has sufficient blood supply and high survival rate without vascular anastomosis and major artery injure of lower limb. So it is an ideal flap for repairing the tissue defect around the foot dorsum, heel, malleolus, sole and knee.