摘要
目的探讨扩大切取范围的腓肠肌肌皮瓣存活的解剖基础及其临床应用。方法进行腓肠肌肌皮瓣的显微解剖研究,设计扩大切取范围的腓肠肌肌皮瓣,分析总结2003年～2005年我们改良腓肠肌肌皮瓣的切取范围后所行的35例腓肠肌内侧头肌皮瓣、17例腓肠肌外侧头肌皮瓣的切取范围及临床效果,验证改良切取范围的腓肠肌肌皮瓣的安全性及实用性。结果52例皮瓣成活良好,35例腓肠肌内侧头肌皮瓣中1例远端坏死,再行内踝上皮瓣修复;2例远端浅表坏死,其中1例再植皮修复,1例换药愈合;1例植皮失败后重新植皮成活。17例腓肠肌外侧头肌皮瓣中2例远端浅表坏死,其中1例再植皮修复,1例换药愈合。结论扩大切取范围的腓肠肌肌皮瓣的血运基础是包括腓肠动脉在内的多源性血供;腓肠肌肌皮瓣的改良扩大了皮瓣的切取范围,增加了皮瓣的切取面积,其适应证也相应扩大;改良的腓肠肌肌皮瓣血供可靠,成功率高,手术相对简便易行。
Objective To introduce the improved gastrocnemius myocutaneous flap with enlargement of area;to summary its clinical effects and approach the anatomic basis of blood supply of the improved gastrocnemius myocutaneous flap.Methods 52 improved gastrocnemius myocutaneous flap have been done during 2003-2005 since we advanced this technique.among these,35 were medial gastrocnemius myocutaneous flap,and 17 were lateral.we analyze and summary these flaps in order to authenticate its clinical reliability and utility.Results All of the 52 flaps were survial.Marginal necrosis taken place in 1 cases among medial gastrocnemius myocutaneous flaps,which have been repaired by medial supramalleolar flap;superfecial marginal necrosis taken place in 2 cases among medial,one of which repaired by changing dressings,and another repaired by dermoplasty.superfecial Marginal necrosis taken place in 2 cases among lateral flaps,one of which repaired by changing dressings,and another repaired by dermoplasty.Conclusion ①The anatomic basis of blood supply of the improved gastrocnemius myocutaneous flap is multiple origin of perforators;②The improved gastrocnemius myocutaneous flap enlarge the area of donor site of gastrocnemius myocutaneous flap,so as to extend its indication;③The improved gastrocnemius myocutaneous flap have reliable blood supply and high ratio of survival,and it's easy to operate,so it deserve to be spreaded.
