吻合腓动静脉腓肠神经移植的应用

目的：研究腓肠动脉对腓肠神经的营养，为吻合腓血管的腓肠神经神经移植提供依据。方法：通过５１例尸体腓血管对腓肠神经供应解剖学研究，以及对４８例临床病例的观察总结。结果：腓动脉有１～７条皮支营养腓肠神经，术中观察腓肠神经两断端出血活跃，修复长段神经缺损优良率８５．４％。结论：吻合腓血管的腓肠神经是神经移植的优良供体     

小隐静脉蒂动脉化腓肠神经移植修复上肢神经缺损

目的 探讨应用小隐静脉蒂动脉化腓肠神经移植修复上肢神经缺损的治疗效果。方法 小隐静脉蒂动脉化腓肠神经移植修复上肢神经缺损11例11条神经，其中尺神经损伤5条，同时伴有尺动脉损伤，正中神经损伤3条，伴有桡动脉损伤1条，桡神经损伤3条。结果 术后10例获得随访，1例失访，随访时间2年10个月～11年10个月，总优良率为80％。结论 小隐静脉蒂动脉化腓肠神经移植是修复上肢神经缺损的有效方法。     

腓肠神经移植修复周围神经缺损116例

目的：为进一步探讨神经移植修复周围神经缺损的效果。方法：从１９８５年１１月至１９９５年６月，用腓肠神经移植治疗周围神经缺损１１６例。结果：经８个月至１０年的随访，结果优良率达７７．８％。结论：施以熟练的显微外科技术，增加长段移植神经的血运和术后辅助高压氧治疗，能有效地促进神经功能的恢复。     

腓肠神经移植修复桡神经深支损伤

目的 报道不同长度腓肠神经移植修复桡神经深支缺损的临床疗效。方法伤后3个月内的桡神经深支缺损2l例，缺损1～2cm者6例，2～5cm者12例，5～8cm者3例。采用相应长度腓肠神经移植修复。结果随访6个月至10年，平均13个月，21例桡神经深支功能均恢复较好，肌力均在Ⅳ～Ⅴ级。结论小于8cm长度的桡神经深支缺损，神经移植修复效果较满意。     

静脉血营养的腓肠神经游离移植

1989年8月28日,为1例左上臂桡神经缺损长达13.5cm的患者采用了静脉供血的带小隐静脉蒂的腓肠神经游离移植修复,获得了初步疗效,现报道如下。 病 例 介 绍 女,30岁,住院号55887。因车祸致左胸     

静脉蒂动脉化腓肠神经移植修复长段神经缺损

我院自1988～1995年应用静脉蒂动脉化腓肠神经移植修复周围神经长段缺损(8cm 以上)者11例,共12条神经,获得满意疗效,报道如下。临床资料本组男8例,女3例。年龄7～42岁,平均26.2岁。其中急诊1例,择期10例。致伤原因:机械牵拉撕脱伤7例,跌伤2例,交通事故伤1例,枪伤1例。损伤的12     

腓肠神经移植修复桡神经深支缺损的疗效分析

目的 探讨腓肠神经移植修复桡神经深支缺损的手术技巧及临床疗效. 方法 2002年5月至2011年6月,对26例陈旧性桡神经深支损伤患者二期修复,行腓肠神经移植术.神经缺损长度为1.2～5.5 cm.缺损在其近侧、不涉及分支者,根据其粗细将切取神经裁为2～3段并固定在一起,将几股神经的两端0.5～0.8cm相邻外膜切除后,再把两端保留的相邻外膜缝合,形成一个共同外膜,移植于缺损处；缺损涉及分支者,则将几股神经近端外膜修整缝合后与损伤神经近端缝合,远端几股分别与分支吻合. 结果 术后创口均一期愈合.26例患者均获随访,随访时间14～ 39个月,平均24.5个月.末次随访时,2例完全恢复,拇长伸肌肌力5级；20例大部分恢复,拇长伸肌肌力4级；3例部分恢复,拇长伸肌肌力3级；1例疗效较差,拇长伸肌肌力2级. 结论 应用腓肠神经移植二期修复桡神经深支缺损,可取得较好的临床疗效.     

吻合血管的腓肠神经移植修复前臂远端尺动脉和尺神经缺损

目的 探讨吻合血管的腓肠神经移植术的临床治疗效果。方法 自1998年5月～2001年10月，应用吻合小隐静脉的腓肠神经移植修复低位尺神经尺动脉缺损97例。结果 所有患者随访6～84个月，参考Clawson。和Seddon，氏评价标准，优良率80．4l％，其中急诊手术患者优良率为89．74％，Ⅱ期手术优良率为74．14％。结论 吻合小隐静脉的腓肠神经移植术是修复前臂远端尺动脉和尺神经缺损的有效方法、神经血管切取方便、操作简单、切取范围大、神经较粗、可折叠。颠倒吻合血管后可同时修复动脉，改善肢体血供，能防止神经坏死，有利于神经修复，疗效肯定。     

应用腓肠神经营养血管皮瓣修复踝足部软组织缺损

目的报道应用腓肠神经营养血管蒂逆行岛状筋膜皮瓣修复踝足部软组织缺损的临床效果。方法临床应用4种术式，1组：既不结扎蒂部小隐静脉，又不吻合向心性静脉11例；2组：吻合向心性回流静脉10例；3组：结扎蒂部小隐静脉13例；4组：既结扎蒂部小隐静脉又吻合向心性回流静脉13例。结果1组11例中术后1个月内有5例出现明显肿胀，有3例皮瓣远端边缘部分坏死，有2例半年后皮瓣臃肿。2组、3组、4组术后1个月皮瓣肿胀分别是3例、3例和1例。皮瓣出现部分坏死分别为1例、1例和0例。半年后皮瓣臃肿分别是1例、1例和0例。结论第4组的临床效果优于前3组。     

小隐静脉-腓肠神经营养血管筋膜皮瓣的临床应用

目的：总结小隐静脉-腓肠神经营养血管筋膜皮瓣的临床应用体会，探讨皮瓣血供特点及扩大皮瓣面积的方法。方法：对26例应用该皮瓣修复小腿骨折后骨外露并感染，骨不连，胫前皮肤溃疡长期不愈。踝关节开放骨折脱位并肌腱外露。足跟皮肤缺损跟腱断裂的病例进行回顾性分析。结果：除2例远端边缘少许表皮坏死，其余皮瓣全部成活感染无复发；骨折愈合；外观，功能恢复满意。结论：该皮瓣不伤及重要血管，血供可靠，是修复小腿及足踝部皮肤软组织缺损的理想方法，尤适用于小腿主要血管损伤时。     

腓肠神经营养血管皮瓣的临床应用

目的探讨腓肠神经营养血管皮瓣的临床应用特点。方法应用腓肠神经营养血管皮瓣逆行、顺行或交腿转移修复小腿中下段及足踝部软组织缺损18例。结果本组术后皮瓣全部成活,蒂部及皮瓣供区均完全愈合,软组织缺损均修复。术后平均随访12(6～24)个月,20周时感觉功能评定:S28例,S2 6例,S34例;供体神经功能无明显影响。结论腓肠神经营养血管蒂恒定,变异极少,手术操作简单,动脉供血可靠,静脉回流充分,不牺牲主干动脉,供区损伤少,创面大部分可直接缝合,可重建感觉,皮瓣成活率高,是修复小腿中下段及足踝部创面的理想选择。     

Dual-Perforator Flap With Wide Pedicle Versus Sural Neurocutaneous Flap With Peroneal Artery Perforator in the Treatment of Soft Tissue Defects of Foot and Ankle

How to deal with large soft tissue defects around the foot and ankle is still controversial. The aim of this study was: (1) to display a new pedicled flap, also named the dual-perforator flap with wide pedicle (DPFWP), and (2) to compare it with the sural neurovascular flap with peroneal artery perforator (SNFPAP) in foot and ankle reconstruction. According to different surgical methods, 82 patients were divided into 2 groups: the DPFWP group (42 cases) and the SNFPAP group (40 cases). All cases underwent a flap surgery after radical debridement. The 2 groups were homogeneous in terms of age, sex, body mass index (BMI), etiology, location, and follow-up duration. Operation indexes were compared, including flap length, flap width, operation time and blood loss. Complications, cosmetic appearance, and functional outcome were analyzed, and statistical analysis was performed. The DPFWP group had larger flap length (24.5 ± 4.6 cm vs 16.3 ± 3.8 cm), and flap width (10.5 ± 2.7 cm vs 7.8 ± 1.7 cm) than the SNFPAP group. In postoperative follow-up, DPFWP group showed a lower complication rate and better cosmetic, functional outcomes than SNFPAP group. In conclusion, this study showed that a DPFWP flap brought better results than a SNFPAP flap in terms of complications, cosmetic appearance, and functional outcomes for patients undergoing reconstruction of foot and ankle defects.     

Malignant Peripheral Nerve Sheath Tumor Arising in Association With the Sural Nerve

Malignant peripheral nerve sheath tumor is a rare sarcoma of peripheral nerves found most often in deep soft tissue. This aggressive tumor is difficult to diagnose clinically and must be surgically excised for therapy. An incisional biopsy will allow for testing and in most cases, diagnosis. The authors present a case of a 39-year-old African American woman with malignant peripheral nerve sheath tumor in association with the sural nerve. The tumor was surgically removed and sent for pathologic studies. The patient reported to her first postoperative appointment and was referred to an oncologist for follow-up. Despite multiple attempts at contacting the patient and explaining the prognosis of the diagnosis, the patient refused further follow-up care including referral to an oncologist.     

逆行腓动脉穿支蒂腓浅神经营养血管皮瓣修复足踝软组织缺损

目的评价逆行腓动脉穿支蒂腓浅神经营养血管皮瓣修复足踝软组织缺损的临床效果。方法对25例足踝部软组织缺损的患者采用逆行腓动脉穿支蒂腓浅神经营养血管皮瓣进行修复。其中,以腓动脉终末穿支的升支为蒂19例,以其降支为蒂6例。软组织缺损大小10cm×9cm～4cm×3cm,皮瓣面积11cm×9.5cm～6cm×5cm。结果 23例皮瓣完全存活,另2例皮瓣远端部分坏死,经换药后植皮修复。皮瓣术后轻度肿胀,无瘀血。术后随访6～18个月,皮瓣质地优良,蒂部无臃肿。结论以腓动脉穿支为蒂的腓浅神经营养血管皮瓣血供可靠、质地优良,是修复足、踝软组织缺损的良好选择。     

腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果

目的 探讨腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果。方法 选取2019年1月-2022年 12月本院收治的30例足踝皮肤软组织缺损患者为研究对象,均应用腓动脉穿支皮瓣进行修复,观察术后 皮瓣成活情况,比较患者治疗前后的足踝功能及生活质量。结果 30例患者皮瓣成活率为96.67%;治疗后 皮肤外观、疼痛程度、皮肤感觉及功能评分均高于治疗前,差异有统计学意义（P＜0.05）;治疗后躯体 功能、角色功能、社会功能、睡眠质量、情绪状态均高于治疗前,差异有统计学意义（P＜0.05）。结论 腓动脉穿支皮瓣修复足踝皮肤软组织缺损的临床效果良好,术后皮瓣成活率较高,可有效改善患者的足 踝功能及生活质量。     

Quantitative Assessment of Peroneal Artery Pressure at the Ankle With Noninvasive Vascular Testing

Although the foot and ankle derives its arterial supply from a combination of the anterior tibial artery (ATA), posterior tibial artery (PTA), and peroneal artery (PA), the focus of clinical examination techniques and noninvasive vascular testing is primarily on the ATA and PTA and not on the PA. The objectives of the present investigation were to evaluate the feasibility of incorporating an assessment of the PA into a noninvasive vascular testing protocol and to collect normative data of pressure measurements of the PA at the ankle. We attempted to locate a Doppler signal of the PA posterior to the lateral malleolus in consecutive patients undergoing our institution's standard protocol for lower extremity noninvasive vascular testing using the ankle-brachial index and photoplethysmography. An audible signal of the PA with an available pressure measurement recording posterior to the lateral malleolus was found in a large majority (92.0%) of the studied legs with peripheral arterial disease. We also found pressure measurements in the PA generally equivalent to that of the ATA and PTA. The mean ± standard deviation systolic pressure of the PA was 130.33 ± 44.74 (range 54 to 255) mm Hg, with a corresponding ankle-brachial index of 0.92. The results of the present investigation provide unique information on a potentially underappreciated aspect of lower extremity vascular anatomy with the potential to affect rearfoot surgical decision making and planning.