腓肠神经营养血管远端蒂筋膜皮瓣的改进运用

Modified sural nerve reverse fascio-cutaneous flap and its' application

目的:探讨降低腓肠神经营养血管远端蒂筋膜皮瓣旋转点和保留腓肠神经的可行性。方法:通过50块腓肠神经营养血管远端蒂筋膜皮瓣的解剖研究,进行21例改进。其中9例超长皮瓣以腓动脉下段携带其外踝上终末肌间隔穿支及外踝后间隙细小穿支为血供降低皮瓣旋转点、增大旋转半径;12例小面积皮瓣仅以外踝后间隙细小穿支为血供降低旋转点,同时保留腓肠神经于供区。结果:18例改进运用的皮瓣全部成活,1例低旋转点超长筋膜皮瓣和2例保留腓肠神经的皮瓣发生远端部分坏死,经补充植皮修复创面。随访6个月～2年,21例筋膜皮瓣的保护性感觉恢复,外形良好,不影响穿鞋行走。保留腓肠神经的病例其足踝外侧皮肤浅感觉依然存在。结论:改进后的皮瓣旋转点低、旋转半径增大,对小面积皮瓣还可保留腓肠神经感觉区,从而能够更好的修复小腿中上1/3至足趾根部的软组织缺损。

Objective To investigate the possibility to lower the rotating point of sural nerve reverse fascio-cutaneous flap without cutting off the sural nerve. Methods 50 sural nerve reverse fascio-cutaneous flaps were transferred, and 21 flaps were modified. 9 ultralong flaps were lifted with the terminal small perforators of lower part of the fibular arteries in the spatium intermusculares of the lateral malleolus and small perforators of the lateral malleolus posterior spatium as the pedicles, so the rotating point of the flap was lowered and the rotating radius were increased. 12 small flaps were lifted only with small perforators of the lateral malleolus posterior spatium as the pedicles without cutting off the sural nerve. Results 18 modified flaps survived well, small necrosis happened at the distal part of one ultralong flap of lower rotating point and two flaps without cutting off sural nerve, and the wounds were repaired with skin graft. Sensation of the 21 flaps was recovered and all the flaps showed satisfactory contour with 6 months to 2 years＇ following up, sensation of the lateral malleoulus without cutting the sural nerve were kept. Conclusions The Modified sural nerve reverse fascio-cutaneous flap is better for repairing the wounds from the upper-middle part of the leg to the dorsal base of toes with lower rotating point and increased rotating radius,to the small flap, the sural nerve can be remained to keep the sensation of the lateral dorsal foot.