腓肠神经伴行血管为蒂的逆行筋膜皮瓣的临床应用

目的探索改善腓肠神经伴行血管为蒂的逆行筋膜皮瓣静脉回流、恢复腓肠神经供区皮肤感觉的有效手术方法.方法行小隐静脉-大隐静脉端-端吻合(VA)、腓肠神经-隐神经端-侧吻合(NR).结果本组8例患者,其中5例如行VA、2例加行NR.3例未行VA者术后皮瓣均发生水泡等静脉回流障碍现象;5例加行VA者除1例因手术意外发生皮瓣远端干性坏死外均无静脉回流障碍;2例加行NR者,1例术后2个月皮瓣和足外缘皮肤感觉重现(另1例随访中).结论加行VA可解决皮瓣静脉回流问题;加行NR既不影响隐神经供区皮肤感觉,又可恢复腓肠神经供区的皮肤感觉.

The Reversed Island Fasciocutaneous Flaps Supplied by the Vascular Axis of Sural Nerve

Objective: To improve the venous drainage of the reversed island fasciocutaneous flap supplied by the axis of sural nerve, and to restore hypesthesia at the flap and the lateral part of the foot after suffered from the loss of the sural nerve. Methods: To improve venous drainage of the flap by using end - to - anastomosis of small sapheneous vein and great sapheneous vein (VA). To restore hypesthesia suffered from the loss of the sural nerve by using end - to - side neurorrhaphy of sural nerve and sapheneous nerve(NR). Results: Total 8 cases were operated. 3 cases without using VA occurred blister venous congestion. 5 cases were additional used VA. All the 5 flaps were well venous drainage except 1 case was necrosis at the distal parts of the flap due to operation lapse. 2 cases were combinatively used NR. The hypesthesia were restored after 2 months of operation in one case. Another one's results were unknown because of the shortage of the recovery time. Conclusion: VA could solve the venous drainage problem of the flap. NR could restore the sensation at the region innervated by sural nerve, including the sensation at the flap and the lateral part of the foot.