改良式腓肠神经滋养血管逆行岛状皮瓣临床应用.doc

改良式腓肠神经滋养血管逆行岛状皮瓣临床应用[摘要]目的：论证保留部分腓肠神经的小腿后侧筋膜皮瓣的成活可靠性和手术方法。方法：17例应用腓肠神经滋养血管逆行岛状皮瓣修复足、踝部创面，6例保留腓肠神经或部分腓肠神经，携带深筋膜保证皮瓣的血运供应。结果：17例皮瓣全部成活，6例保留腓肠神经的皮瓣成活良好，腓肠神经支配区域皮肤感觉正常或部分存在。结论：保留腓肠神经或部分腓肠神经的所谓腓肠神经滋养血管皮瓣完全成活，减少了神经损伤，有利于术后功能康复。 [关键词]保留腓肠神经；改良；腓肠神经滋养血管皮瓣 [中图分类号]R622 [文献标识码]A [文章编号]1008-6455（2012）02-0198-02 The clinical application about reforming sural vasa nervorum flyback island skin flap SHEN Yun-biao,YE Xiang-bai,WANG Xi-hua,XIA Lai-qi,CHEN Zhong-yong,LI Jin-xi,SU Ying （Department of Plastic Surgery, Urumqi General Hospital,Lanzhou Military Region,Uygur Autonomous Region 830000,Xinjiang,China） Abstract: Objective To explore the reliability and operation method of the meta- leg fascia skin flap which reserve portion sural nerve. Methods The 17 raw surfaces of foot and ankle have been repaired with sural vasa nervorum flyback island skin flap. The other 6 cases reserved intact sural nerve or portion sural nerve, the blood of skin flap provided by deepfascia. Results The 17 sural vasa nervorum flyback island skin flaps all survived well. The 6 cases which reserved portion sural nerve survived good,the skin sensation of area dominated by sural nerve is normal or part existence. Conclusion The sural vasa nervorum flyback island skin flap which reserve intact or portion sural nerve can survive well, and keep the merit with less nerve injury, this merit profit for functional rehabilitation. Key words:sural nerve;reforming;sural vasa nervorum flyback island skin flap 腓肠神经滋养血管皮瓣因其操作相对简单，供区破坏小、成活率高、手术效果良好，成为小腿下端和足部深度创面修复的首选皮瓣。我院自2004年以来，对于足部、踝部深度创面大多采用该皮瓣和隐神经皮瓣修复，现就此手术的临床方法进行分析总结，供同道参考。 1 资料和方法 1.1 临床资料：本组共17例，选择保留腓肠神经或部分腓肠神经的皮瓣6例，均为逆行转移修复足跟和踝部，保留神经后观察皮瓣血运良好，术后12天拆线，皮瓣完全成活，正常携带腓肠神经的皮瓣足踝部感觉缺失，而保留神经的皮瓣术后小腿足部腓肠神经支配区域皮肤感觉正常。 1.2 手术方法：6例皮瓣均采取逆行转移，设计与正常皮瓣一样，中轴尽量向内侧偏移2cm，目的是尽可能使腓肠神经居于皮瓣外侧，有利于分离保留神经，减少损伤腓肠外侧皮神经。皮瓣蒂部转折点选择在外踝上5.0cm，皮瓣大小（5.0～10.0cm）×（6.0～8.5cm）。皮瓣解剖首先选择中线最上端切开皮肤和皮下组织，轻轻提起深筋膜，手术刀切开小口，用小的圆头组织剪沿设计线剪开深筋膜，在深筋膜下方找到小隐静脉，一般情况下腓肠神经与之伴行，小心游离出神经，用橡皮条