腓肠神经-小隐静脉营养血管逆行皮瓣的临床应用改进

The clinical application of modified distally-based flaps of sural nerve nutrient vessel

目的探讨腓肠神经一小隐静脉营养血管逆行皮瓣修复下肢缺损的改进应用方法及效果。方法将其皮瓣系列改进设计：（1）皮瓣回流静脉干高压时予以结扎小隐静脉干，或与受区静脉吻合；（2）对供瓣区超过小腿中上1／3部位时，行皮瓣延迟8—14天；（3）行腓肠神经干、支与受区神经支吻按，重建皮瓣感觉；（4）设计低位旋转点（约外踝尖上3e111）皮神经皮瓣；（5）切取携带部分薄层腓肠肌肉的皮瓣。几种方法常同时应用。结果自2000年9月～2007年12月，本组临床应用42例，除极少数例皮瓣远端约有1—2cm宽的不同程度坏死外，余例皮瓣均成活，随访3个月～2年，功能外形恢复满意。结论改进后的腓肠神经一小隐静脉营养血管逆行皮瓣血运丰富，成活率高，手术操作简便，可较好地修复大多数小腿难治性组织缺损。

Objective To investigate the application and therapeutic effect of modified neurovascular flaps nourished by sural nerve and small saphenous venous, Methods We made some modifications for the flaps, （1）The small saphenous venous were ligated or anastomosed with the venous in recipient area; （2）The flap was delayed 8 - 14 days if the donor area was above the middle and upper one third of leg;（3）The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap;（4）The lower turning point could be designed just 3cm above the point of external malleolus;（5） Partial gastrocnemius could be included in the flap if needed. Results From Sep, 2000 to Dec, 2007, 42 cases were treated, Partial necrosis （about 1 cm -2cm width） happened in the distal end of flaps in a little cases which healed after treatment of dress changing, All flaps survived completely . The patients were followed up from 3 months to 2 years with satisfied functional and cosmetic results. Conclusion The modified flaps have reliable blood supply and survival rate. The operation is easily performed and very practical. The flaps can repair many refractory defects in legs.