摘要
目的对以腓动、静脉为蒂的跨供区皮瓣进行解剖学研究,并探讨临床应用效果,为足踝部大面积软组织缺损的修复提供新方法。方法自2016年6月至2019年8月,取成人下肢标本12例,用过氯乙烯-乙酸乙酯-氧化铅及红色过氯乙烯-乙酸乙酯行腘动脉灌注,解剖观测腓动脉穿支的发出位置、数量、外径、走行及分布,小腿后外侧区皮肤营养血管来源、分布、交通吻合情况,观察腓动、静脉与腓肠神经营养血管之间的血供关系;设计并应用以腓动、静脉为蒂跨供区皮瓣修复足踝部大面积软组织缺损9例,术后通过门诊及电话随访。结果 12侧成人下肢标本中,腓动脉发出穿支共65条,每侧(5.41±1.00)(4~7)条,其穿深筋膜处直径为(1.07±0.36) mm。穿支多集中分布距外踝4.0~11.0 cm、16.0~21.0 cm及24.0~27.0 cm 3个区段内,分别占穿支总数的48%、24%、17%,穿支外径分别为(0.92±0.26)(0.56~1.68) mm、(1.32±0.38)(0.60~2.14) mm和(0.98±0.28)(0.62~1.36) mm,穿支血管蒂长分别为(3.91±0.96)(2.15~5.78) cm、(5.34±0.50)(4.01~5.85) cm和(3.31±1.15)(2.16~5.66) cm。此3个区段穿支恒定出现,且管径均≥0.5 mm,蒂长为(4.19±1.16)(2.15~5.85) cm。小腿后外侧区域皮肤血管网主要由真皮下血管网和深筋膜层血管网2层血管网构成。小腿后外侧区域深筋膜血管网可看到3条明显纵向链式吻合,包括腓肠内侧神经营养血管链、小隐静脉-腓肠神经交通支血管链及腓肠外侧神经营养血管链,接受来自腓动脉穿支的营养血供,腓动脉穿支链之间也形成纵向与横向吻合。临床应用中9例足踝部大面积软组织缺损均得以修复,复合组织瓣成活,无感染及坏死,术后功能及外形良好,供区外观良好。随访12个月~3年,患者行走正常。依据美国矫形足踝协会(AOFAS)足评分标准对患足功能进行评定,优5例,良4例。结论以腓动、静脉为蒂的跨供区皮瓣血供充分,切取面积大,为足踝部大面积软组织缺损的修复提供了一种新的方法。
Objective Anatomical study of the cross-donor flap pedicled with the peroneal artery and the discussion of the effect of clinical application,so as to describe a new method for the repair of large-area soft tissue defects in the foot and ankle.Methods From June 2016 to August 2019,12 specimens of adult lower limbs were studied.The popliteal arteries were perfused with perchloroethylene-ethyl acetate-lead oxide and red perchloroethylene-ethyl acetate.The origin,number,outer diameter,course and distribution of perforating branches of the peroneal artery were anatomically observed.The source,distribution and anastomosis of the skin nutrient vessels in the posterolateral area of the calf were also studied.Relationship of the blood supply between the peroneal arteries and veins and the nutritional vessels of the sural nerve were observed.In 9 patients,the peroneal artery and vein were designed as the pedicle of cross-donor flap in the repair of large soft tissue defects of foot and ankle.The patients were entered follow-up through outpatient visits and telephone interviews.Results Among the 12 adult specimens of lower limbs,there were 65 perforating branches from the peroneal artery,4-7 branches on each side,with an average of(5.41±1.00)branches.The diameter of the penetrating deep fascia was(1.07±0.36)mm.The perforator branches were mostly dis・tributed in 3 sections of 4.0-11.0 cm,16.0-21.0 cm and 24.0-27.0 cm away from the lateral malleolus,accounting for 48%,24%and 17%of the total number of perforators,respectively.The outer diameters of the perforator vessels were(0.92±0.26)(0.56-1.68)mm,(1.32±0.38)(0.60-2.14)mm,and(0.98±0.28)(0.62-1.36)mm.The length of the pedicle of the perforator vessels were(3.91±0.96)(2.15-5.78)cm,(5.34±0.50)(4.01-5.85)cm,and(3.31±1.15)(2.16-5.66)cm.The perforating branches in the 3 sections appeared constantly.The diameter of the vessels was M 0.5 mm with an average length of at(4.19±1.16)(2.15-5.85)cm.The vascular network of the flap in the posterolateral area of the calf was mainly composed of subdermal vascular network and deep fascial vascular network.The deep fascia vascular net・work in the posterolateral area of the calf had 3 obvious longitudinal chains,including the medial sural neurotrophic vascular chain,the small saphenous vein-sural nerve communicating branch vascular chain and the lateral sural neurotrophic vascular chain,which took the nutrient blood supply from the perforating branches of the peroneal artery also formed a longitudinal and transverse anastomosis between the perforating branches of the peroneal artery.In the clinical trials performed on 9 patients,all soft tissue defects of foot and ankle were repaired.The composite tissue flap survived without infection or necrosis.The follow-up was lasted for 12 months to 3 years.The postoperative function and the donor site appearance were good and the patients walked normally.According to the American Orthopaedic Foot and Ankle Association(AOFAS)foot scoring standard,the function of affected feet were evaluated.Five patients were excellent and 4 were good.Conclusion The cross-donor flaps pedicled with peroneal arteries and veins has sufficient blood supply and a large area.It provides a method for the repair of large-area soft tissue defects in the foot and ankle.
作者
于承祺
刘勇
王剑利
郑浩
郭佳
隋志强
李健
张雪涛
王蕾
YU Chengqi;LIU Yong;WANG Jianli;ZHENG Hao;GUO Jia;SUI Zhiqiang;LI Jian;ZHANG Xuetao;WANG Lei(Weifang Medical College,Weifang,Shangdong Province 261000,China;Affiliaied Hospital of Weifang Medical College,Weifang,Shangdong Province 261000,China;Hospital of PLA 80 th Group Army,Weifang,Shangdong Province 261000,China;Weifang People 5 Hospital,Weifang,Shangdong Province 261000,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2022年第1期71-76,共6页
Chinese Journal of Microsurgery
基金
中国人民解放军后勤科研面上项目(CLJ18J020)。
关键词
外科皮瓣
腓血管
跨供区皮瓣
足踝部
应用解剖
Surgical flap
Peroneal vessels
Cross donor flap pedicled
Foot and ankle
Applied anatomy
