皮神经营养血管皮瓣的成活机制研究

Survival Mechanism Research of Neurocutaneous Vascular Flap

目的总结应用皮神经营养血管皮瓣修复四肢皮肤软组织缺损创面的临床经验及改进手术方法的效果。方法在探讨皮瓣临床设计应用原则基础上改进切取方法,扩大皮瓣切取面积,设计吻合浅静脉改善逆行皮瓣的静脉回流,创新设计穿支蒂皮神经皮瓣解决逆行皮瓣转位时蒂部扭转、折叠及外形臃肿问题,进一步扩大皮瓣成活面积及修复范围。结果临床应用63例65块皮瓣,其中腓肠神经、隐神经、腓肠外侧皮神经、股内侧皮神经、前臂皮神经、掌背皮神经顺行或逆行皮瓣44块;腓动脉、胫后动脉及骨间前血管的穿支蒂皮神经皮瓣21块。应用吻合皮下浅静脉法19块。皮瓣面积30cm×10cm～2.5cm×1.5cm。59例61块皮瓣完全成活,4例部分成活。随访6个月～5年,皮瓣质地优良,外形与功能恢复满意。结论该类皮瓣设计灵活,切取方便,血供可靠,是修复四肢皮肤软组织缺损创面的理想方法。吻合浅静脉有利于改善逆行皮瓣的静脉回流,扩大皮瓣成活面积。穿支蒂皮神经皮瓣为临床提供了新概念及新方法。

Objective To sum up the improved operative technique and clinical experience of using neurocutaneous vascular flap to repair soft tissue defects in the extremities.Methods On the basis of determining the principle in the design and elevation, the operative techniques were modified to enlarge the elevating area of the flap; The superficial vein of the flap were anastomosed with that of the recipient site to improve the venous drainage; A new neurecutaneous vascular axial flap with perforating vessels as a pedicle were developed to avoid the disadvantages of previous technique like pedide torsion or swell appearance, and to enlange the survival and repairable area d the flap. Results 65 flaps in 63 cases were applied clinically, 61 flaps were sunrived eompletdy, 4 flaps sunrived partially.Direct or retrograde flow flaps based on the sural nerve, the saphenous nerve, the lateral sural cutaneous nerve, the intemalfemoral cutaneous nerve, the antibrachial cutaneous nerve and the dorsal hand cutaneous nerve nutritional vessels were used in 44 flaps, perforating neurocutaneous axial flaps pedide with perforators derived from the peroneal, the posterior tibial and the dotal branch of anterior intercssea vessels were used in 21 flaps.Anastomosis of the flap＇ s superficial veins were used in 19 flaps.The size of flaps ranged from 30cm×10cm to 2.5cm × 1.5cm.The color and texture of flaps were good, the appearante and functional results were satisfactory after 6 - 60 months follow - up. Conclusions This kind of flap is characterized by delicate designation, easy dissection and reliable blood supply, it is an idea method in repairing the skin defects of the extennities.Anastomosis of the flap＇ s superficial veins can significantly improve the venous drainage and enlarge the survival area of the flap.Perforator- based neurocutaneous vascular flap provide us a new practical operative methods and new concept of the flap.