远端带蒂的腓骨短肌瓣ppt课件.pptVIP

The distally pedicled peroneus brevis muscle flap A new flap for the lower leg summary Defect in distal region of the leg Exposure of tendons,bones,or osteosynthetic mateial Can not be covered by free skin transplants Local or free-tissue flaps must be used Gastrocnemius ,soleus,proximal pedicled peroneus brevis muscles flaps usually be used Because the radius of extension in the distal direction is small Not suitable for covering defect in lateral or medial malleolus,distal Achilles tendon We prefer to use relatively elaborate free flaps A new flap for the lower leg Modification of the peroneus brevis muscle flaps The defect can be covered rapidly,reliably and securely Blood is supplied to the muscle by a distal pedicle,the transposed muscle covered with splitthickness skin grafts Long peroneus muscle,peroneus artery remain intact Patients and methods 1993-1999,19patients,average age 51years Lesion treated 10 lateral malleolus 5 following necrosis of Achille stendon 2 distal edge of tibia 2 medial malleolus Patency tested peroneal and PT artery by Doppler preoperatively The condition of DM or,as in one case,systemic scleroderma did not represent a contraindication Anatomy and blood supply Short peroneus muscle originates on lateral surface of fibula and inserts at tuberosity of 5th metatarsal bone It tendon runs together with that of the long peroneus muscle alone posterior surface of the lateral malleolus Peroneal musculature act as a pronator in lower ankle joint and as a flexor in upper joint Short peroneal muscle is innervated by branches of superficial peroneal nerve Its arterial supply is provided by peroneal artery,which sends out several segmental branches to the muscle along its course About 3 finger-breadths proximal to the tip of the fibula