摘要目的 报道吻合血管的腓动脉穿支蒂腓肠神经营养血管长轴皮瓣的应用解剖及其临床应用效果.方法 10侧下肢标本采用有色乳胶经腘动脉灌注,解剖观测腓动脉穿支血管的分布、走行及管径,寻找适合用于吻合血管的穿支血管.2007年4月至2010年1月,采用吻合血管的腓动脉穿支蒂腓神经营养血管长轴皮瓣游离移植修复前臂及手部大面积软组织缺损6例.缺损范围15 cm × 6 cm～45cm×10 cm.皮瓣面积为16 cm×8 cm～30 cm×10 cm,血管蒂长4～6 cm.结果 腓动脉沿途平均发出5.3支穿支血管,在腓骨中下1/3交界处存在恒定的适合用于吻合血管的穿支血管,血管外径为(1.21±0.13)mm,血管蒂长(4.6±0.8)cm.6例皮瓣完全存活,随访3～12个月,皮瓣质地优良,外形与功能恢复满意.结论 以腓动脉穿支为蒂的腓肠神经营养血管长轴皮瓣切取范围大,穿支血管蒂长,管径适中,血供可靠,对小腿功能影响小,是临床修复前臂及手部大面积软组织缺损的良好选择.

abstractsObjective To report the anatomical study and clinical application of the free peroneal perforator-based sural neurofasciocutaneous flap. Methods Latex injection studies were performed on 10 adult cadaveric lower limbs. The presence, prevalence, and location of the peronel perforators that were suitable for vascular anastomosis were documented. From April 2007 to January 2010, 6 patients with large soft tissue defects in the upper limb underwent the reconstructive procedures with the free peroneal perforatorbased sural neurofasciocutaneous flap transfers. 4 patients were men and 2 were women, with the age ranging from 19 to 60 years. The causes of the injury included 4 motor vehicle accidents, and 2 massive machinery trauma. The area of the flap ranged from 16 cm × 8 cm to 30 cm × 10 cm, and the length of the perforator pedicle was 4 cm to 6 cm. Results A mean of 5.3 perforating vessels of the peroneal artery was noted in the specimen. The peroneal perforator that located at the junction of the middle and lower thirds of the fibula was found suitable for microsurgery, with the external diameter and the length being (1.21 ± 0.13)mm and (4.6 ± 0.8)cm respectively. All the 6 flaps survived completely without necrosis. No severe venous congestion was observed. All the patients were satisfied with the aesthetic outcome postoperatively at 3 to 12 months'follow-up. There were no major donor site complications. Conclusion The free sural neurofasciocutaneous flap based on a single peroneal perforator is an excellent tool for reconstruction of extensive soft tissue defects in the upper limb.