吻合穿支游离腓肠神经营养血管腓骨皮瓣的临床应用

Clinical application of free sural neurocutaneous vascular flap containing single perforating artery to fibular flap graft

目的:探讨单一穿支腓肠神经营养血管腓骨皮瓣游离移植修复肢体软组织、骨联合缺损的手术方法及临床效果。方法:切取由腓动脉发出单一主皮穿支腓肠神经营养血管腓骨皮瓣,单纯吻合穿支动静脉或吻合穿支动脉、小隐静脉,游离移植修复涉及远足的合并骨缺损创面。结果:临床应用5例,骨皮瓣面积12 cm×7 cm^18 cm×11 cm,均全部成活,随访时间7~16个月,外观满意,质地优良,感觉恢复均达S3级以上,移植腓骨愈合时间4~10个月。结论:该术式结合了游离皮瓣、穿支皮瓣与皮神经营养血管皮瓣的优点,骨皮瓣设计灵活,切取方便,修复部位随意,血供可靠,符合生理,是肢体创伤修复重建的一种可取方法。

Objective： To explore the operative techniques and clinical effects of transplantation of free sural neurocutaneous vascular flap containing single perforating artery from peroneal artery with fibular graft for repair of bone and soft tissues defects. Methods.. A composite flap composed of single perforating artery from peroneal artery and fibular graft was designed to repair skin and metatarsus defects at forefoot. Perforating artery and perforating vein or the perforating artery and lesser saphenous vein were anastomosed, respectively, when the transplantation was performed. Results： All composite flaps in 5 cases （ ranged from 12 cm×7 cm to 18 cm×11 cm） were transplanted successfully without necrosis, and no vascular problems occurred. Follow - up time was 7 to 16 months, and sensation had recovered to more than S3 degree in all eases with excellent results including satisfactory limb appearance. Fibular graft healing time was 4 to 10 months. Conclusion= This operation method combines the advantages of free flap, perforator flap and neurocutaneous flap. This composite flap has many advantages such as easy dissection, flexible design, unrestricted recipient location, reliable blood supply and meeting the physiological needs. It＇s a good method to repair and reconstruct of limb trauma.