摘要目的:探讨"两点两线法"在游离腓肠内侧动脉穿支皮瓣中的设计和切取的可行性及临床意义。方法:自2022年9月至2023年6月，苏州瑞华骨科医院采用"两点两线法"指导术前穿支定位及皮瓣设计，成功切取30例腓肠内侧动脉穿支皮瓣，其中修复手部创面21例、足踝部创面9例。软组织缺损面积为2.5 cm×2.5 cm~7.0 cm×14.5 cm，皮瓣切取面积为3.0 cm×3.0 cm~7.5 cm×15.0 cm。供区直接缝合或植皮修复。术后门诊随访6~15个月，采用皮瓣综合评价量表评价供、受区恢复情况；用英国医学研究会（BMRC）感觉功能评定标准评定皮瓣感觉功能。结果:术中均成功寻找到穿支，共见穿支47条，均为肌皮穿支，其中14例为1条穿支，15例为2条穿支，1例为3条穿支。术后30例皮瓣均完全成活，其中2例出现动脉危象，经手术探查后顺利成活。所有供区均一期愈合。采用皮瓣综合评价量表评分为84~96分，平均92.5分，优27例，良3例，优良率100%；采用BMRC评定皮瓣感觉功能结果：S 1 1例，S 2 17例，S 3 12例。 结论:采用"两点两线法"设计腓肠内侧动脉穿支皮瓣，方法简单，定位准确，是一种方便可行的术前设计方法。

abstractsObjective:To study the feasibility of design and harvest of free medial sural artery perforator flap with the "two-point and two-line method".Methods:From September 2022 to June 2023, Suzhou Ruihua Orthopaedic Hospital implemented the "two-point and two-line method" to guide preoperative perforator positioning and flap design. Thirty medial sural artery perforator flaps were successfully harvested with the method, and 21 wounds of hand and 9 of foot and ankle were reconstructed with the flaps. The size of soft tissue defects were 2.5 cm×2.5 cm-7.0 cm×14.5 cm, and the flaps size were 3.0 cm×3.0 cm-7.5 cm×15.0 cm. All donor sites were directly closed or by skin grafting. All patients were entered in 6-15 months of postoperative outpatient follow-up, and the recovery of donor and recipient sites was assessed by the comprehensive evaluation scales. The sensory function of the flaps was evaluated using the sensory function evaluation standard of British Medical Research Council (BMRC).Results:All perforators were successfully located with 47 perforators in total, and all of them were musculocutaneous perforator. It was found that there was 1 perforator in 14 flaps, 2 perforators in 15 flaps and 3 perforators in 1 flap. All 30 flaps survived after surgery, beside 2 flaps that had arterial insufficiency but survived successfully after surgical exploration. All donor sites healed in one stage. Comprehensive evaluation scale of flap was employed to evaluate the flaps and the scores were 84 points to 96 points with an average score of 92.5 points. The excellent and good grades were achieved in 27 flaps and 3 flaps, respectively, with a combined excellent and good rate at 100%. Sensation of the flaps was evaluated by BMRC with 1 flap of S 1, 17 of S 2 and 12 of S 3. Conclusion:The "two-point and two-line method" has been used in design of the perforator flap of medial sural artery. This method is simple and accurate, and is feasible and ideal in design of flaps before surgery.