小腿前外侧皮瓣及腓浅神经营养血管为蒂岛状皮瓣的临床应用

目的 探讨小腿前外侧皮瓣与腓浅神经营养血管岛状皮瓣的解剖关系及临床应用价值.方法 对手部软组织缺损采用吻合腓浅血管的小腿前外侧皮瓣移植修复7例;对足踝部软组织缺损采用带腓浅神经营养血管为蒂逆行岛状皮瓣修复7例;对小腿中上段骨外露创面采用以腓浅动脉为蒂顺行岛状皮瓣修复4例、中下段骨外露创面采用以上方腓浅动脉及下方腓浅神经营养血管共同为蒂构成联合皮瓣推移修复13例.结果 吻合腓浅血管的小腿前外侧皮瓣7例、以腓浅动脉为蒂顺行岛状皮瓣4例、以上方腓浅动脉及下方腓浅神经营养血管共同为蒂的联合皮瓣13例,上述皮瓣均完全成活;以腓浅神经营养血管为蒂逆行岛状皮瓣7例,6例皮瓣完全成活,1例皮瓣术后静脉回流障碍皮瓣远端部分坏死经扩创后植皮愈合.结论 小腿前外侧皮瓣游离皮瓣与腓浅神经营养血管为蒂的逆行岛状皮瓣在解剖上存在代偿关系,利用二皮瓣的血管解剖联系可扩大二皮瓣的切取面积及应用范围.

Clinical appfications of the anterolateral skin flap in the lower leg and the reversed superficial peronealneurocutaneous island flap

Objective To investigate the anatomy and clinical effect of the anterolateral skin flap in the lower leg and the reversed superficial pereneal neuracutaneous island flap. Methods Seven cases of hand skin defect were treated with anterolateral skin flap in the lower leg with vascular anastomosis. 7 cases of ankle soft tissue loss were repaired with reversed superficial peroneal neurocutaneous island flap. 4 cases of the tissue defects in the middle and proximal parts of the leg and 13 cases of the tissue defects in the middle and distal parts of the leg were repaired with sequential superficial peroneal artery island flap and combined flap of super-ficial peroneal artery island flap and superficial peroneal neurocutaneous island flap respectively. Results Seven cases of the anterolateral skin flap in the lower leg with vascular anastomosis, 4 cases of the sequential superficial peroneal artery island flap and 13 cases of the combined flap of superficial peroneal artery island flap and superficial peroneal neurocutaneous island flap were survived.Becanse of vein drainage disturbance which led to partial necrosis of flap, one case of the reversed superficial peroneal neurocutaneous island flap was de-layed healing with epluehage and skin grafting. Conclusion The anterolateral skin flap in the lower leg and the reversed superficial peroneal neurocutaneous island flap compensate each other anatomically. The operation based on the anatomy enlarges the size of the flap and extends the scope of reconstruction.