腓肠神经营养血管蒂岛状皮瓣的应用解剖

Applied anatomy of island flap pedicled with nutrient vessels of sural nerve

目的 :为带腓肠神经营养血管蒂岛状皮瓣的临床应用提供解剖学依据。方法 :在 3 8侧经动脉灌注红色乳胶成人下肢标本上解剖观测腓肠神经及营养血管的起始、走行、分支分布、吻合及外径 ,2侧成人新鲜下肢标本墨汁灌注观察营养血管的墨染范围。结果 :腓肠神经由腓肠内侧皮神经与腓神经交通支汇合而成 ,其汇合点在外踝上 12 .7± 3 .7cm ,腓肠神经沿窝中点至外踝与跟腱中点连线下行 ,外踝上 12 .6± 3 .4cm处穿出深筋膜。其营养血管主要来源于窝中间皮动脉和腓动脉肌间隔穿支 ,上段起始部外径 0 .6± 0 .1mm ,下段距外踝上 6.7± 1.6cm处与腓动脉穿支恒定吻合 ,吻合支外径 0 .6± 0 .1mm ,沿途发出众多筋膜皮支营养小腿后部皮肤。结论 :以腓肠神经及其营养血管为蒂可设计切取顺行或逆行岛状皮瓣。

Objective:To provide anatomic basis for clinical application of island flap pedicled with nutrient vessels of sural nerve.Methods:The origin,course,branches,distribution,anatomosis and outer diameter of sural nerve and its nutrient vessels were observed on 38 sides adult low extremity specimens perfused with red latex.The blood supply range of nutrient vessels was observed on 2 sides fresh low extremity specimens injected with black ink.Results:Sural nerve were comprised by sural medial neurocutaneous and comunicating branch of peroneal nerve at 12.6±3.4 cm above lateral malleolus.It perforated from deep fascial at 12.6±3.4 cm above lateral malleolus.Its nutrient vessels mainly originated from politeal medial cutaneous artery and perforating branch of peroneal artery.They sent many fascial cutaneous rami to supply the posterior skin of leg.Conclusion:The antegrade or retrograde island flap could be designed by sural nerve and its nutrient vessels.