游离腓浅动脉穿支皮瓣的临床研究

Clinical application of the free superficial peroneai artery perforator flap

目的研究腓浅动脉穿支皮瓣的应用解剖及游离移植的临床效果。方法15具新鲜成人尸体行动脉造影及螺旋CT扫描，数据以DICOM格式输入MIMICS图像工作站，进行三维可视化处理，观测腓浅动脉穿支血管的分布规律等。临床应用游离腓浅动脉穿支皮瓣修复手足创面12例，缺损面积为3．0cm×4．5cm～5．0cm×11．0cm。结果腓浅动脉起始外径（1．2±0．3）mm，干长（5．6±1．8）cm。其穿支多出现于小腿前外侧上、中1／3区域，平均外径（0．7±0．2）mm，与中、下1／3处腓浅下外侧动脉及腓动脉终末穿支吻合构成1条几乎不减少口径的血管链，伴行静脉1条。12例穿支皮瓣全部成活，受区外形及功能恢复满意，供区外形功能无明显影响。结论腓浅动脉穿支皮瓣血管蒂解剖恒定，手术操作简便，临床效果满意，是游离移植修复创面的又一选择。

Objective To investigate the applied anatomy of the superficial peroneal artery perforator flap and report the clinical results of repairing the soft tissue defects with free perforator flaps. Methods 15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized software （Materiaise＇s interactive medical image control system, MIMICS）. The origin, course and distribution of the superficial peroneal artery perforator in the anterolateral leg region were observed. Clinically 6 cases with hand defects and 6 cases with feet defects were treated with free superficial peroneal artery perforator flap transplantation. The defect size ranged from 3.0 cm ×4.5 cm to 5.0 cm × 11.0 cm. Results The diameter of the superficial peroneal artery is （ 1.2 ±0.3） mm at its origin from the anterior tibia1 artery 5 cm below the fibula head. It is （5.6 ± 1.8） cm in length. This artery is truly anastomosed with other perforators to form the chain of superficial peroneal nerve accessory artery. The superficial peroneal artery perforators [ outer diameter （0.7±0. 2） mml with a vein are in the anterolateral leg region, supplying the skin in proximal-middle region. All the 12 cases were treated successfully. The clinical results were satisfactory after 3-12 months of following-up. Conclusions The superficial peroneal artery perforator flap has constantly, reliable blood supply, and good texture. It is a good option for repairing soft-tissue defect with free transfer.