穿支蒂腓浅神经营养血管皮瓣修复外踝部皮肤缺损
Perforator-based neurocutaneous vascular flap of superficial peroneal nerve for ankle reconstruction
目的 报道利用穿支蒂腓浅神经营养血管皮瓣修复对外踝部皮肤软组织缺损。 方法 利用便携式多普勒超声仪，在创缘周围探测腓动脉发出的穿支，以其中最合适的穿支为旋转点及血管蒂，沿腓浅神经轴线切取穿支蒂皮瓣逆向转位修复外踝部伴有肌腱及骨外露的创面。 结果 本组9例，男6例，女3例；年龄20～45岁，平均32岁；皮肤软组织缺损面积为3 cm×5 cm～7 cm×11 cm；皮瓣切取面积为4 cm×6 cm～8 cm×12 cm。皮瓣存活良好，颜色正常，修复效果好。平均随访两个月，患者步态正常，无疼痛，但其中2例患者抱怨小腿外侧区及足背有麻木感。 结论 穿支蒂腓浅神经营养血管皮瓣设计灵活，切取方便，血供可靠，适于修复外踝部的皮肤软组织缺损创面，是一种皮神经营养血管皮瓣与穿支蒂皮瓣相结合的优良皮瓣。
Objective To report the perforator-based neurocutaneous nutritional flap of the superficial peroneal nerve for covering soft-tissue defects around the lateral malleolus. Methods The portable Doppler ultrasound was employed to locate the perforators from the peroneal artery, and the most appropriate one was adopted as the vascular pedicle; based on this perforator, the retrograde perforator-based neurocutaneous nutritional flap of the superficial peroneal nerve was harvested for coverage of soft-tissue defects around the lateral malleolus complicated by exposure of the tendon and the bone, with its axis based on the direction of the nutritional plexus of the superficial peroneal nerve. Results 9 cases were included in this group, with 6 of them being male, 3 of them being female; their ages fell between 20 and 45 years old, with an average of 32 years old. The size of the defect ranged from 3cm×5 cm to 7cm×11cm, and the size of the flap ranged from 4cm×6 cm to 8cm×12 cm. All flaps survived well, with excellent color and reparative outcome. After an average 2-month follow-up, all patients were pain-free and can ambulate with normal gaits. Conclusions The perforator-based neurocutaneous nutritional flap of the superficial peroneal nerve is a versatile flap that can be manipulated to resurface the complicated soft-tissue defects around the lateral malleolus. It is a pliable flap with a reliable blood supply and an optimal combination of the perforator flap and the neurocutaneous nutritional flap.
Superficial peroneal nerve / Perforator-based flap / Lateral malleolus / Reconstruction
[1] Bertelli JA, Khoury Z. Neurocutaneous island flaps in the hand: anatomical basis and preliminary results
[J]. Br J Plast Surg,1992,45(8):586-590.
[2] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves: anatomic study and clinical experience in the leg
[J]. Plast Reconstr Surg, 1992,89(6):1115-1121.
[3] 展望，宁金龙. 腓肠神经营养血管及筋膜蒂小腿后部逆行岛状皮瓣的应用
[J].中国临床解剖学杂志，1998,16(2):176-177.
[4] 陈瑞光，叶伟雄，吴劲风，等. 逆行腓肠神经营养血管岛状皮瓣的临床应用
[J]. 中国修复重建外科杂志，2000,14(4)：220-222.
[5] 李泽龙，丁自海，王培信，等. 大隐静脉-隐神经营养血管皮瓣的临床解剖与应用
[J]. 中国修复重建外科杂志，2006,20(3)：259-263.
[6] Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle
[J]. Br J Plast Surg, 1989,42(6):645-648.
[7]. Hallock GG. Direct and indirect perforator flaps: the history and the controversy
[J]. Plast Reconstr Surg,2003, 111(2):855-865.
[8] Geddes CR, Morris SF, Neligan PC. Perforator flaps: evolution, classification, and applications
[J]. Ann Plast Surg,2003,50(1):90-99.
[9] Koshima I, Inagawa K, Yamamoto M, Moriguchi T. New microsurgical breast reconstruction using free paraumbilical perforator adiposal flaps
[J]. Plast Reconstr Surg, 2000,106(1):61-65.
[10]Cormack GC, Lamberty BG. A classification of fascio-cutaneous flaps according to their patterns of vascularisation
[J]. Br J Plast Surg, 1984,37(1):80-87.
[11]Rikimaru H, Kiyokawa K, Inoue Y, et al Three-dimensional anatomical vascular distribution in the pectoralis major myocutaneous flap
[J]. Plast Reconstr Surg,2005,115(5):1342-1352.
[12].Saint-Cyr M, Wong C, Schaverien MV, et al. The perforasome theory: vascular anatomy and clinical implications
[J]. Plast Reconstr Surg,2009,124(5):1529-1544.
[13]Chang SM, Hou CL. Chain-linked directional vascular plexuses of the integument and link-pattern vascularized flaps in distal extremities
[J]. Plast Reconstr Surg, 1998,101(7):2013-2015.
[14]钟世镇，徐永清，周长满，等.皮神经营养血管皮瓣解剖基础及命名
[J].中华显微外科杂志,1999,22(1):37-39.
[15]柴益民，林崇正，邱勋永，等. 带皮穿支血管的皮神经营养血管皮瓣的临床应用
[J]. 中华整形外科杂志, 2006，22(1)：34-37.
[16]Kim JS, Son DG, Choi TH, et al. An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps
[J]. Ann Plast Surg, 2008,60(6):710-716.
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