腓肠外侧动脉穿支与腓肠外侧皮神经营养血管联合蒂肌皮瓣的临床应用

Clinical application of the compound muscle flap combined by the lateral sural artery perforators and the nutrient vessels of the lateral sural cutaneous nerve

目的观察腓肠外侧动脉穿支与腓肠外侧皮神经营养血管的解剖位置关系，并设计二者联合蒂肌皮瓣．通过临床应用探讨其临床效果。方法在5具（10侧）成人下肢新鲜标本上，观测记录腓肠外侧动脉穿支与腓肠外侧皮神经营养血管的解剖位置关系；并据此设计二者联合近端蒂肌皮瓣，临床应用5例，皮瓣大小6cm×9cm～9cm×12cm。结果腓肠外侧动脉入肌后沿途发出3～5支外径为0．2-1．8mm的肌皮穿支，营养腓肠肌外侧头及周围皮肤，并与腓肠外侧皮神经营养血管参与形成浅、深筋膜血管网。自2009年2月至2011年11月，临床应用5例腓肠外侧动脉与腓肠外侧皮神经营养血管轴联合蒂肌皮瓣修复膝前及胫骨上端皮肤缺损，4例一期愈合，1例远端部分浅表坏死，经换药逐渐愈合。结论设计的联合蒂肌皮瓣有两套血供，血运丰富，扩大了皮瓣切取面积；同时皮瓣内带有感觉神经，保证了皮瓣感觉，可以修复膝关节周围较复杂皮肤软组织缺损。皮瓣蒂部不臃肿，转移方便，不损伤主要血管，创伤小，易于临床推广应用。

Objective To observe the anatomic relationship between the lateral sural artery perfora- tors and the nutrient vessels of the lateral sural cutaneous nerve that were combined to design a compound muscle flap. And to observe the effect of this flap clinical application. Methods Ten adult and fresh ca- daver lower limbs were observed the anatomic relationship between the lateral sural artery perforators and the nutrient vessels of the lateral sural cutaneous nerve, and were combined to design a compound muscle flap. Clinically applied in 5 cases, and the flap sizes ranged from 6 cm× 9 cm to 9 cm × 12 cm. Results After into the muscle,the lateral sural artery issued 3-5 perforating branches （OD：0.2-1.8 mm） along the way, which provided nutrition for the lateral head of the gastrocnemius and the surrounding skin and involved in the formation of shallow and deep fascia vascular network with the nutrient vessels of the lateral sural cuta- neous nerve. From Feburary 2009 to November 2011, the compound pedicled muscle flap were clinically ap- plied in 5 cases to repair the skin defects of the anterior knee and proximal tibia. Flaps in 4 cases completely survivedand 1 case had partial superficial necrosis on the distal part of the flap, which healed after dressing change. Conclusion The compound pedicled muscle flap has two sets of blood supply that could expand the area of the flap, which could guarantee its feeling. This kind of flap could repair the complicated skin and soft tissue defects around the knee joint.