不携带肌袖的游离腓骨瓣制备技术

目的 介绍一种不携带肌袖的改良游离腓骨瓣制备方法。方法 通过分析腓骨血供的解剖学特点，设计一种不携带肌袖的游离腓骨瓣制备方法。手术时，按外侧面、前面、后面和内侧面的顺序依次剥离附丽于腓骨四周的肌肉，重点是腓骨后方拇长屈肌和腓骨内侧面胫后肌的剥离，应仔细分离、切断和结扎腓动脉发至上述两块肌肉的细小分支。结果 采用此方法共完成游离腓骨瓣下颌骨重建35例，全部腓骨瓣均在1小时内完成制备，无一例损伤腓动静脉，术后全部腓骨瓣及其所携带的皮岛均获得成活，无一例出现血管危象和受区血肿，无一例出现供区并发症，患者术后下肢功能的恢复明显优于传统腓骨瓣术后的患者。结论 不携带肌袖的游离腓骨瓣制备技术最大限度地保留了小腿肌肉的完整性，减少了术后受区和供区并发症的发生，同时也不会影响腓骨瓣血供的可靠性，值得进一步观察和应用。

A modified technique for harvesting the free fibula flap without a muscle cuff

Objective To introduce a modified technique for harvesting a free fibula flap without a muscle cuff.Methods Initially, the characteristics of the blood supply of the fibula were analyzed and then a modified technique for harvesting the free fibula flap without muscle cuff was developed. During the surgical operation, the normal arterial pattern of the leg was performed followed the harvesting of the flap. The muscles around the fibula were stripped in sequence first from the lateral aspect, then from the anterior, posterior, and finally the internal aspect. All vital vessels and nerves were protected during the operation. Results From April of 2002 to October of 2003, a total of 35 free fibula flaps were transfered by using this modified technique. All of the flaps were used for mandibular reconstruction. The fibula flaps as well as the skin paddles survived completely without any vessel thrombosis. There were no obvious complications for the donor sites. Conclusion The modified technique for harvesting the free fibula flap is feasible and reliable. It greatly reduces donor site complications such as hematomas and foot weakness without compromising the blood supply of the fibula flap.