摘要目的 探讨腓肠神经-小隐静脉营养血管逆行皮瓣、隐神经-大隐静脉营养血管逆行皮瓣修复下肢缺损的改进应用方法及效果.方法 根据其解剖学特点、受区病损情况,对该2组皮瓣进行系列改进设计:①皮瓣回流静脉干高压时予以结扎大、小隐静脉干,或与受区静脉吻合;②对供辨区超过小腿中上1/3部位时,行皮瓣延迟8～14 d;③行腓肠神经干、支与受区神经支吻接,重建皮瓣感觉;④设计低位旋转点(内、外踝尖上3 cm)皮神经皮瓣;⑤切取携带部分薄层腓肠肌或比目鱼肌肌皮瓣;⑥当患腿局部邻近皮瓣无法利用时,可采用逆行交腿皮神经皮瓣.上述等方法可同时应用.结果 1994年9月至2007年4月,临床应用63例,其中腓肠神经-小隐静胸营养血管逆行皮瓣51例,隐神经-大隐静沟营养血管逆行皮瓣12例,除早期2例皮瓣远端约有1～2 cm宽的不同程度坏死,经换药而愈,余均成活,随访3个月～2年,功能外形恢复满意.结论 该2组改进皮瓣应用后血运丰富,成活率高,手术简便,安全可靠,单独或联合应用可满足小腿难治性组织缺损70%病例的修复.

abstractsObjective To investigate the application and therapeutic effect of modified neurovaseular flaps nourished by sural nerve and small saphenous venous,or saphenous nerve and great saphenous venous.Methods According to the anatomy and recipient area,we made some modifications for the two neurovascular flaps.①The small and great saphenous venous were ligated or anastomosed with the venous in recipient area;②The flap was delayed for 8～14 days if the donor area was above the middle and upper one third of leg;③The sural nerve and its branch were anastomosed to the nerve in recipient site to restore the sense of flap;④the lower turning point could be designed just 3 cm above the point of internal and external malleolus;⑤Partial gastrocnemius or soleus muscle could be included in the flap if needed;⑥Reversed cross leg flap was considered if the adjacent flap in the affected side could not be used.Sometimes,we adopted more than one modification in one patients.Results From Sep,1994 to Apr,2007,63 cases were treated,including 51 cases of sural and 12 cases of saphenous neurovaseular flaps.Partial necrosis(about 1～2 cm width)happened in the distal end of flaps in 2 cases which healed after dress changing.The patients were followed up for 3 months to 2 years with satisfied functional and cosmetic results.Conclusions These two modified flaps have reliable blood supply and survival rate.The operation is easily performed and very practical.The flaps,or combined with other methods can repair about 70％of the refractory defects in legs.