小腿后外侧穿支皮支链的解剖学研究

Anatomic study of cutaneous branches- chain based on the cutaneous perforators of the posterolateral lower leg

目的探讨小腿后外侧穿支皮支链形成的具体区域,为临床切取小腿后外侧穿支皮支链皮瓣提供解剖学基础。方法新鲜成人尸体下肢标本15侧,(女性2侧,男性13侧),皮肤无外伤及手术史。13侧下肢经股动脉行红色乳胶灌注,手术显微镜下进行精细解剖,充分显示各穿支间的链状吻合,并于穿深筋膜处测量各穿支的外径。2侧下肢制做血管铸型标本,观察皮支链的构筑。结果小腿后外侧穿支数为67支,每侧(5.15±1.86)支,穿深筋膜处的直径为(0.92±0.25)mm;腓骨长度为(34.78±17.78)cm,参与构成小腿后外侧皮支链的穿支数为34支,每侧为(3.31±1.65)支,直径为(0.99±0.23)mm,占所在区域穿支的(28.33±17.79)%^(64.04±19.48)%。结论根据小腿后外侧穿支皮支链分布规律和形式切取皮瓣,不但可适当扩大皮瓣的切取面积,也使皮瓣的血供更加安全。

Objective To define the specific area of cutaneous branches- chain flaps based on the cutaneous perforators of the posterolateral lower leg, and to provide the anatomical basis for taking the cutaneous branches-chain flap. Methods A total of 15 fresh adult cadaveric lower legs（2 female, 13 male）with no history of trauma and surgery were studied. 13 specimens were perfused with red latex for microanatomical analysis, and then the outer diameter of the cutaneous branches at the level of deep fascia was measured. Additionally, 2 specimens were perfused with self- curing denture acrylic to get vascular cast mold for observing the linking pattern of the cutaneous perforators. Results A total of 67 cutaneous perforators came from the posterolateral lower leg was observed in our study, with an average（5.15±1.86） on each side; the diameter of perforators at the deep fascia was（0.92 ± 0.25）mm; The length of fibula was（34.78 ± 17.78） cm. There are 34 cutaneous perforators participating in the formation of branches- chain, with an average（3.31±1.65） on each side; the diameter of perforators was（0.99±0.23）mm; the area of brancheschain of the posterolateral lower leg ranged from（28.33 ± 17.79）% to（64.04 ± 19.48）%. Conclusion The cutaneous branches- chain flaps based on the cutaneous perforators of the posterolateral lower leg could be harvested to expand the range of skin flap and ensure safety for harvest of the flap.