低旋转点腓肠神经营养血管皮瓣的解剖学研究-外科学专业论文.docx

低旋转点腓肠神经营养血管皮瓣的解剖学研究 摘要 皮神经伴行血管岛状皮瓣修复软组织缺损早在 1992 年被提出并应用于临 床。腓肠神经营养血管皮瓣修复创面具有邻近转移、切取方便、成活率高等诸多 优点，已成为足踝部软组织缺损修复的常选供区。但该皮瓣旋转点较高，转移修 复对患者损伤大，且较难修复远端足踝部创面。近年来，临床上报道多用低旋转 点腓肠神经营养血管逆行皮瓣来修复踝足部组织缺损。目前为止国内少见相关解 剖及影像学的报道，我们对该皮瓣进行了应用解剖学及影像学的研究，以期对临 床应用提供理论依据。 目的：为低旋转点腓肠神经营养血管远端蒂皮瓣的临床应用提供解剖学及影 像学基础。方法：成年尸体标本 10 具,以乳胶灌注法对小腿浅层神经，动脉穿支 的起始、走行、分支和分布进行详细解剖观测。对足踝部血管正常的病人行下肢 DSA 造影，收集病例资料，将收集到的各项资料进行整理，分析低旋转点腓肠神 经营养神经血管的位置，走行及动态血流图像，直观深入的了解此部分的血供情 况。结果：10 具标本(20 侧)中，测量了 10 侧腓肠神经，其长度为(13.5±5.0)cm。 在小腿正中 1/2 处测量腓肠神经主干横径为(2.5±1.2)mm，并下行渐变细。腓动 脉肌间隔穿支与营养血管恒定吻合,吻合支外径(0.6±1.0)mm。腓肠外侧动脉发出 2-5 支，外径 (0.2±1.2)mm。肌皮穿支穿出深筋膜后至皮下，形成血管网，营养 腓肠肌外侧头及相应区域皮肤。小隐静脉的远端部存在浅深交通支,位于小隐静 脉外侧占 75%(15 侧)，位于小隐静脉内侧的占 25%(5 侧)。DSA 显影效果良好， 外踝上 3cm，有 1-2 支浅深交通支，较为粗大。结论：低旋转点的腓肠神经营养 血管远端蒂皮瓣血供可靠，能够满足临床应用需要。 关键字：腓肠神经；低旋转点；DSA. Anatomic study on lower rotating point nutrient vessels of sural nerve flap Abstract Neurocutaneous concomitant vessel island flap for repairing of soft tissue defect was proposed and applied to clinical in 1992. Sural neurovascular flap t o repair the wound has many advantages like adjacent transfer,harvesting easy, alive rate high, has become a common district for ankle soft tissue defect repa iring. But the flap rotating point is so high that transfer operation for repairing caused larger damage to a patient, and more difficult to repair of distal foot trauma. In recent years, many clinical reports with lower rotating point sural neurocutaneous vascular flap to repair tissue defect of foot and ankle. But so far,related anatomy and imaging of the reports were rare in the domestic, we study the flap applied anatomy and imaging, in order to provide theoretical ev- idence for its clinical application. Objective: To provide anatomical and imagical basis for the application of the lower rotating point distally based sural nerve nutrient vessel pedicle flap. Method： Ten cadavers which were perfused by red latex were used in this study. The lower leg superficial nerve