The Clinical Application of Medial Sural Vessels as Recipient Vessels in Repairing Traumatic Tissue Defects in the Lower Limbs
The Clinical Application of Medial Sural Vessels as Recipient Vessels in Repairing Traumatic Tissue Defects in the Lower Limbs
复制标题
腓肠内侧血管作为受体血管修复下肢创伤性组织缺损的临床应用
DOI：
10.1097/sap.0000000000002156
复制
发表时间：
2020-04-01
影响因子：
1.5
通讯作者：
Gao, Jianhua
中科院分区：
文献类型：
--
作者：
Fu, Jile;Gao, Junqing;Gao, Jianhua
背景使用腓肠内侧血管（MSVs）作为受体血管修复下肢创伤已有报道。然而，关于暴露msv的方法和伤口的可修复区域存在争议。方法采用8具新鲜尸体，测定腘窝血管产生的小血管瓣的形状、外径和长度。应用游离背阔肌皮瓣修复下肢创面7例。皮瓣面积18 × 11 cm ~ 24 × 17 cm，术后随访7 ~ 60个月。结果腓肠内侧动脉以腘动脉为起点的外径为2.48±0.24 mm。血管下降29.98±4.62 mm后进入肌内；进入时血管外径为2.24±0.17 mm。值得注意的是，血管进入肌肉仅2 cm后外径为1.88±0.09 mm。临床治疗7例。在6例中，我们使用腓肠肌内侧头和胫骨之间的入路来暴露和吻合MSVs。1例血管内径不匹配。术后6例皮瓣完全成活。其余病例皮瓣远端表皮坏死，并自行消退。无明显并发症。结论腓肠肌内侧头与胫骨之间的入路可以方便地在外侧位置显露和吻合msvv。以背阔肌为受体血管的背阔肌瓣在距骨区修复肢体创伤方面是有效的。
BackgroundThe use of medial sural vessels (MSVs) as recipient vessels to repair wounds in the lower limbs has been previously reported. However, there is controversy regarding the methods used to expose MSVs and the repairable area of the wound.MethodsEight fresh cadavers were used to determine the shape, outer diameter, and length of the MSVs arising from the popliteal vessels. Lower extremity wounds were repaired in 7 patients using free latissimus dorsi flaps with the MSVs as recipient vessels. The flap area ranged from 18 x 11 cm to 24 x 17 cm, and the postoperative follow-up time ranged from 7 to 60 months.ResultsThe outer diameter of the medial sural artery from the starting point of the popliteal artery was 2.48 +/- 0.24 mm. After descending 29.98 +/- 4.62 mm, the vessels entered the muscle; the outer diameter of the blood vessel upon entry was 2.24 +/- 0.17 mm. Notably, the outer diameter of the vessel was 1.88 +/- 0.09 mm only 2 cm after entering the muscle. Seven cases were treated clinically. In 6 cases, we used an approach between the medial head of the gastrocnemius muscle and the tibia to expose and anastomose the MSVs. In 1 case, the vascular diameter was mismatched. After surgery, the flap survived completely in 6 cases. The remaining case experienced epidermal necrosis in the distal part of the flap, which resolved spontaneously. There were no obvious complications.ConclusionsAn approach between the medial head of the gastrocnemius muscle and the tibia can easily expose and anastomose the MSVs in a lateral position. Latissimus dorsi flaps were useful in repairing limb wounds as far as the talocrural region with the MSVs as the recipient vessels.