带腓浅神经营养血管的远端蒂筋膜皮下组织瓣修复足背缺损

Distally based superficial peroneal neuroadipofascial turnover flap for dorsal foot coverage

目的 :报告带腓浅神经营养血管的远端蒂筋膜皮下组织瓣的血管解剖和临床应用研究。 方法 :通过对 3 2侧固定的下肢标本和 4侧新鲜下肢标本的解剖学研究 ,观察腓浅神经的血供来源及其与小腿筋膜皮肤血供的相互关系。临床上设计带腓浅神经营养血管的小腿前方筋膜皮下组织瓣 ,翻转修复 5例足背创伤缺损。 结果 :腓浅神经由腓浅动脉伴行。在小腿的下1/3段 ,腓浅动脉变细成交织的血管丛 ,并得到胫前动脉肌间隙穿支、腓动脉外踝上穿支和足背动脉回返支的加强 ,在小腿深筋膜表面和皮下组织中 ,形成丰富的深筋膜和皮神经链式吻合纵向血管丛。据此设计带腓浅神经营养血管的远端蒂筋膜皮下组织瓣 ,翻转 180°修复足背创面 5例 ,组织瓣面积 ( 10～ 14 ) cm× ( 4～ 5 ) cm ,蒂宽 3～ 4 cm ,均完全成活。结论 :带腓浅神经营养血管的远端蒂筋膜皮下组织瓣 ,血供丰富 ,方法简单 。

Objective:To study the anatomic and clinical experience in distally based neuroadipofascial turnover flap incorporating superficial peroneal nerve.Methods:Thirty six (32 preserved and 4 fresh) cadaver lower limbs were used to investigate the blood supply of superficial peroneal nerve and the relationship with the vascularization of its vicinity integument.Distally based neuroadipofascial flap incorporating the nutrifying vessels of superficial peroneal nerve was designed for dorsal foot reconstruction.Results:The proximal part of superficial peroneal nerve was supplied by an accompanying superficial peroneal artery.In the one third part of the lower leg,this artery became an interlacing paraneural vascular plexus and was reinforced by branches from the distal perforators of anterior tibial artery,the supramalleolar perforator of peroneal artery,and the recurrent branches of dorsal pedal artery.Two chain linked longitudinal vascular plexuses (fascial and paraneural) were confirmed in the anterior lower leg integument.In practice,distally based superficial peroneal neuroadipofascial turnover flaps were successfully transferred in 5 cases.The flap measured (10 14) cm×(4 5) cm in size.The pedicle was (3 4) cm in width.The pivot point was located (2 3) cm above the line between medial and lateral malleolus.Conclusion:Distally based superficial peroneal neuroadipofascial turnover flap is a simple and safe procedure with minimal morbidity of the donor site.