小腿皮神经-浅静脉营养血管远端蒂复合瓣的解剖学特征与足及小腿下段创伤修复

Anatomical characteristics of the distally based pedicled compound flap with nutrient vessel of cutaneous nerve and superficial vein of leg in repairing trauma of inferior segment of leg and foot

目的:探讨小腿皮神经-浅静脉营养血管远端蒂复合瓣的构建,为临床足部损伤修复提供解剖学理论。方法:实验于2004-01/08在解放军南京军区福州总医院军区临床解剖学研究中心实验室完成。64侧动脉灌注红色乳胶成人下肢标本由南京军区福州总医院军区临床解剖学研究中心提供。60侧动脉灌注红色乳胶的成人下肢标本,以外踝尖、内踝最凸出点为观测标志点,重点显微解剖:①隐神经-大隐静脉、腓肠神经-小隐静脉营养血管的来源、分支及吻合。②皮神经-浅静脉营养血管与胫骨、腓骨、腓肠肌和比目鱼肌的供血关系。另用4侧标本行远端蒂复合瓣摹拟手术。结果:①隐神经-大隐静脉营养血管来源:隐动脉(3～5支)穿皮支、膝下内动脉穿皮支、胫后动脉肌间隙支(2～7)、骨皮穿支(1～2)支、踝前内侧穿皮支、踝上穿皮支和踝管筋膜穿皮支(4～5支)。②腓肠神经-小隐静脉营养血管来自腓动脉肌间隔穿支4～8支,最远的跟外侧动脉穿支距外踝尖上(1.0±1.3)cm,外径(0.6±0.2)mm。③腓肠肌内、外侧头动脉沿途发2～6支的肌皮穿支营养皮神经浅静脉。④胫后动脉肌间隙支营养胫骨、比目鱼肌内侧半。⑤腓动脉肌间隔穿支营养腓骨、比目鱼肌外侧半。上述穿皮支平均外径在0.3～1.6mm,发出皮支、筋膜支、皮神经-浅静脉营养血管,形成皮神经-浅静脉血管链以及深、浅筋膜血管网。结论:小腿皮神经、浅静脉、骨膜、筋膜和皮肤的营养血管同源,可以设计4种皮神经-浅静脉营养血管远端蒂复合瓣,用于足部和小腿下段的创伤修复。

AIM： To discuss the construction of distally based pedicled compound flap with nutrient vessel of cutaneous nerve and superficial vein of leg, to provide anatomical theory for repairing foot injury in clinic. METHODS： The experiment was conducted in Laboratory of Clinical Anatomical Research Center of Military Area Command, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from January to August 2004. Totally 64 adult cadaveric supperior limb specimens perfused with red gelatin were provided by the Clinical Anatomical Research Center of Military Area Command, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. The follows microdissection were emphasized with point of extramalleolus and the most projecture of internal malleolus were made as observation sign on 60 adult cadaveric supperior limb specimens perfused with red gelatin： ① The origins, branches and inosculations of nutrient vessel of saphenous nervegreat saphenous vein and sural nerve-small saphenous vein. ②Nutrient vessel of cutaneous nerve-superficial vein and its blood supply relationship with tibia, fibula and gastrocnemius muscle and soleus muscle. The mimic operation of compound flap of distally based podicled were designed on another 4 samples. RESULTS： ①The origins of nutrient vessel of the saphenous nerve-great saphenous vein forearm was as follows： The cutaneous branches of saphena artery （3-5 branches）, cutaneous branches of artery genu inferior medialis and spatium intermusculare branches of posterior tibial artery （2-7 branches）, bone cutaneous perforating branches （1-2 branches）, cutaneous perforating branch of anterior medialis of ankle, cutaneous perforating branch of upper of ankle and fascia perforating branch of ankle tube （4-5 branches）. ② The origin of nutrient vessel of nervus suralis-small saphenous .vein forearm was as follows： The muscle interval perforating branch of peroneal artery （4-8 branches）. The perforating branch of ext lateral artery of calcar pedis is （1.0±1.3） cm part from lateral malleolus point with diameter of （0.6±0.2） mm. ③The muscle cutaneous perforating branches of artery of caput mediale of musculi gastrocnemii and caput laterale originated from （2-6 branches）, which provided nutrition for cutaneous nerve and superficial vein along the way. ④ Spatium intermusculare branches of posterior tibial artery provide nutrition for the wall half of canna major and soleus muscle. ⑤ The muscle interval perforating branch of peroneal artery provided nutrition for lateral half of fibula and seleus muscle. Above-mentioned perforating branches with average outside diameter of （0.3-1.6） mm, which originated from cutaneous branches, anadesma branches, periosteum branches, nerve-superficial vein nutrition vessel and form cutaneous nerve-cephalic vein vessel chain with deep and superficial fascia and periosteum rete. CONCLUSION： The vessels of the cutaneous nerve of leg and superficial vein have homology with the nutrient vessel of periosteum, fasciae and skin, 4 types of low-swivel distally based compound flap can be designed, which can be applied to repair tissues defect of foot and inferior segment of leg.