带腓肠神经伴行血管蒂岛状皮瓣的解剖学研究

The anatomy study of island flap with vascular axis of the sural nerve

目的探讨带腓肠神经伴行血管蒂岛状皮瓣的最大切取面积，并比较皮神经蒂皮瓣与静脉皮瓣、筋膜皮瓣、传统带蒂皮瓣在成活面积之间的差异性。方法取４侧新鲜成人尸体小腿，从小隐静脉逆行灌注美蓝并观察其蓝染面积的范围。另采用ＳＤ大鼠４０只，随机分成４组，每组１０只。建立大鼠股部皮神经蒂皮瓣及上述３种皮瓣的模型，术后６天测量各组皮瓣成活面积。结果小腿后外侧皮肤出现蓝染面积在１２ｃｍ×１７ｃｍ范围内。大鼠皮瓣成活面积以传统带蒂皮瓣、皮神经蒂皮瓣为佳，两者差异无显著性意义（Ｐ＞０．０５）。筋膜皮瓣次之，静脉皮瓣最差。结论带腓肠神经伴行血管蒂岛状皮瓣的最大切取面积不宜超过１２ｃｍ×１７ｃｍ。术时保留皮瓣内浅静脉和蒂部的部分深筋膜可提高皮神经皮瓣的成活率。

Objective To explore the largest area of island flap with the vascular axis of the sural nerve. To observe the difference of survival area among neurocutaneous flap, vein flap, fascial flap and traditional axis flap through animal experiment. Methods 4 legs of fresh adult cadavers were studied. Methylene blue was perfused into the reversed small saphenous vein. 40 SD rats were divided into 4 groups with 10 rats each. The flap models were set up in rat femur. The survival area was observed at 6 days after operation. Results There is 12 cm×17 cm staining at the posterior lateral legs. According to the area of survival skin, the traditional axis flap and neurocutaneous flap had an excellent result; the fascial flap was the third and the vein flap was the last. Conclusions The island flap with vascular of the sural superficial nerve can be harvested with an area no larger than 12 cm×17 cm. Retaining superficial vein in neurocutaneous flap can increase survival rate of neurocutaneous flap.