逆行腓肠神经营养血管皮瓣的临床应用

Clinical application of reverse sural neurovascular flap

目的探讨腓肠神经营养血管皮瓣逆行转移修复足背、足跟及踝部组织缺损的临床应用效果。方法在应用解剖及对成人小腿和足背长度测量的基础上,设计带筋膜蒂的腓肠神经营养血管岛状皮瓣,逆行应用修复足背、足跟、足底及踝部软组织缺损。同时观察皮瓣的可切取范围、血液供应及静脉回流情况、营养血管在外踝上与腓动脉穿支的位置及血管蒂隧道的处理方案。结果临床应用28例,其中修复足背组织缺损16例,足跟软组织缺损5例,足底软组织缺损4例及外踝及足背联合缺损3例。皮瓣最大面积17 cm×12 cm,全部成活。结论腓肠神经营养血管皮瓣血液循环丰富,成活率高,是修复足背、足跟、踝部、足底部软组织缺损的理想皮瓣。

Objective To explore the clinical application of sural neurovascular flap to be transfered distally for repairing tissue defect around the heel, foot and ankle dorsum. Methods On the basis of applied anatomy and length measure of adult leg and foot dorsum, the distally based sural neurovascular fascial island flap, according to available flap scope, the blood supply and venous return of flap and the position of supply vessel from peroneal artery on external malleus, was designed for repairing tissue defect of foot dorsum, heel, sole malleus, etc distally. Results The flap was used for total 28 cases with a maximum size of 17 cm× 12 cm including 16 cases of foot dorsum defect, 5 cases for heel soft tissue,4 case for sole sort tissue and 3 cases for outermalleolus plus foot dorsum. All flaps survived completely. Conclusion The sural neurovascular flap has sufficient blood supply and high survival rate and it is an ideal flap for repairing the tissue defect around the foot dorsum, heel, malleolus and sole.