逆行腓骨肌肌皮瓣设计的解剖学研究

目的　为逆行腓骨肌皮瓣的设计与临床应用提供解剖学依据。 方法 新鲜下肢标本20侧，动脉灌注红色乳胶，解剖观测腓动脉、腓骨长肌、腓骨短肌及其表面皮肤与营养血管的的起始、走行、分支、分布的情况；新鲜标本2具，动脉灌注乳胶、氧化铅混悬液，CT扫描后三维重建小腿与足部血管。 结果 腓动脉起始外径(3.7±0.7) mm，多条分支供给比目鱼肌、 长屈肌、腓骨长、短肌及表面皮肤。腓动脉穿支的血管蒂可游离长度为(3.5±1.3) cm。腓动脉终末穿支在胫腓骨骨间膜中穿出，外径(1.2±0.4)mm，分为升支和降支。腓骨短肌肌腹的上部有一支较粗的腓浅动脉发自胫前动脉，向前穿骨间膜行于腓骨长肌与小腿前群肌之间，管径(1.8±0.5) mm，行向下营养腓骨短肌、腓浅神经和小腿前外侧部皮肤。 结论 以腓动脉中、下部穿支或终末穿支与其它血管的吻合部为蒂，可以设计切取逆行腓骨长、短肌肌皮瓣，修复小腿下部及足背部软组织缺损。

Anatomical study on the design of the reversed peroneal myocutaneous flap

Objective To apply the visualized anatomical basis for the design and clinical application of the reversed peroneal musclo-cutaneous flap. Methods 20 fresh lower extremity specimens were used with arteries injected with red latex. The musculus peroneus brevis and longus were dissected and the originations, courses, branches and the distributions of the peroneal arteries were studied; Another 2 fresh lower extremity specimens with the arteries injected with plumbous oxide and latex were CT scanned and the bones and arteries were 3D-reconstructed and studied. Results The diameter of the originate peroneal artery was (3.7±0.7) mm, the artery gave off many muscular branches to the soleus muscle, long flexor muscle of great toe, musculus peroneus brevis and longus and the skin. The pedicle of the perforator arteries from the peroneal artery was (3.5±1.3) cm. The last part of the peroneal artery with the diameter of (1.2±0.4) mm, passed through the interosseous membrane of the leg and branched into the ascending and descending branches. Upside of the belly of the musculus peroneus brevis, the superficial peroneal artery, which came from the anterior tibial artery and with the diameter of (1.8±0.5)mm, ran forward and passed through the interosseous membrane and laid between the musculus peroneus longus and the anterior muscles of the leg. Conclusions The reversed musculus peroneus brevis and longus musculo-cutaneous flap pedicled with the cutaneous arteries and the end arteries of the middle and lower part of the leg can be designed and be used to repair the defect of the foot and the lower leg.