小腿前外侧的皮瓣及筋膜瓣的临床应用

Clinical applications of the anterolateral skin flap and the fascial flap in the lower leg

目的介绍小腿前外侧的皮瓣筋膜瓣的应用解剖、手术方式、方法及临床应用。方法在14侧成人下肢标本及1条断腿上,观察了腓浅血管的起始部位、行程及皮支的分布情况,设计了小腿前外侧组织瓣的4种术式。1988年以来,临床应用26例。结果术后皮瓣筋膜瓣全部成活,切口Ⅰ期愈合23例,Ⅱ期愈合3例,20例随访4个月到5年,情况稳定良好,无复发。结论手术操作简单、安全可靠,对供区影响小,是修复小腿及对侧踝及跟部后方创面及治疗胫骨慢性骨髓炎的一种可供选用的方法。

Objective To introduce the applied anatomy,operative method and clinical application of the anterolateral skin flap and fascial flap of the lower leg.Methods Anatomic dissection was per- formed on 14 adult cadavers' legs and one amputated lower limb.The origin,course and distribution of cu- taneous branches of the superficial peroneal vessels were traced.Four types of anterolateral flaps were de- signed in the lower leg including the island skin flap,the island fascial flap,the rectangular flap,and the cross-leg flap.Since 1988,twenty-six cases of leg defects(21 patients),chronic osteomyelitis of the tibia(3 cases)and defects on the back of the opposite heel and ankle(2 cases)were treated with the operative methods.Results All the flaps survived.Primary healing occurred in 23 and secondary in 3 cases.Twenty cases were followed-up for 4 months to 5 years.The flaps were growing well,the tibia fracture healed 3 months after the treatment and the chronic osteomyelitis of tibia had no recurrence.Conclusion This flap is a useful method for repairing various defects in the leg and adjacent regions.It is simple,safe and reliable in manipulation and has minimal influence to the donor site.