吻合血管复合腓骨穿支皮瓣的应用解剖及临床应用

Anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap

目的报道吻合血管的复合腓骨穿支皮瓣的应用解剖及修复复合组织缺损的临床效果。方法24侧下肢标本采用有色乳胶从胭动脉灌注，解剖观测腓动脉及其穿支血管的分布、蒂长、管径等。临床设计切取小腿外侧区的腓动脉穿支皮瓣与游离腓骨形成复合腓骨穿支皮瓣移植修复肢体复合组织缺损共16例。皮瓣面积为6cm×4cm～16cm×8cm，骨缺损长度6～16cm，移植腓骨长度8～20cm。结果腓动脉沿途平均发出5．3支穿支，其中40．6％为肌皮穿支、59．4％为隔皮穿支，分布在腓骨后缘3．1cm范围内，平均直径1．1mm，穿支间距4～8cm，外踝后上方15—25cm、4—7cm范围内均可发现穿支血管。移植的16例复合腓骨穿支皮瓣全部成活，随访10～36个月，平均22．3个月，移植的腓骨在术后3～5个月愈合．随时间延长及患者负重移植骨逐渐增粗。受区外形与肢体功能恢复满意。结论腓动脉穿支数目及位置相对恒定，根据腓动脉皮穿支的发出位置，可设计复合腓骨穿支皮瓣，临床应用证明是修复肢体长段骨缺损合并皮肤软组织缺损的良好选择。

Objective To report the anatomical study and clinical application of the vascularized composite fibula perforating osteoseptocutaneous flap. Methods Latex injection studies were performed on 24 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel artery and its perforators in the distal leg were documented. 16 vascularized fibul osteoseptocutaneous flaps were performed for reconstruction of composite soft - tissue defect of limbs. The flap areas ranged from 6 cm × 4 cm to 16 cm × 8 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. 40.6% of them were muscularcutanous perforators, and the other were septacutanous perforators. The perforating vessels were all located within 3.1 cm from the postlateral fibula. The average diameter was 1.1 mm at the deep fascial level, and the interval of them was 4-8 cm. There were two constant perforators which located about 15-25 cm and 4-7 cm from the lateral maleolar respectively. All of the 16 clinical cases survived uneventfully and the time to union of the graft-host junction site were 3 to 5 months. The appearance of flaps and the function of the limbs were satisfied during 10 to 36 months following up. Conclusion It is the anatomic basis that there are perforating vessels of the peroneal constantly. The vascularized compound fibula perforating osteoseptocutaneous flap has the advantage of flexible design. It is the safe and suitable choice in the cases when compound bone and soft tissue defects of the limbs are required for reconstruction.