DISTALLY BASED SURAL FASCIOMYOCUTANEOUS FLAP: ANATOMIC STUDY AND MODIFIED TECHNIQUE FOR COMPLICATED WOUNDS OF THE LOWER THIRD LEG AND WEIGHT BEARING HEEL
DISTALLY BASED SURAL FASCIOMYOCUTANEOUS FLAP: ANATOMIC STUDY AND MODIFIED TECHNIQUE FOR COMPLICATED WOUNDS OF THE LOWER THIRD LEG AND WEIGHT BEARING HEEL
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DOI：
10.1002/micr.20595
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发表时间：
2009-01-01
期刊：
影响因子：
2.1
通讯作者：
Yu, Guang-Rong
中科院分区：
文献类型：
--
作者：
Chang, Shi-Min;Zhang, Kai;Yu, Guang-Rong
重建远端第三条腿和承重跟，特别是当合并感染和/或死腔时，仍然是重建手术的挑战。腓肠远端神经筋膜肌皮瓣已被证明是修复这些区域软组织缺损的一种有价值的工具。在这篇报告中，我们介绍了筋膜上腓肠神经血管轴与腓肠肌深肌之间的血管交通的解剖学研究结果，以及一种用于重建小腿远端和跟部软组织缺损的改良技术的临床应用。对新鲜尸体的6条下肢注射红明胶并进行解剖。在腓肠筋膜上神经血管轴与腓肠肌深肌之间的重叠区域，平均有4条直径为0.2 ~ 0.5 mm的肌筋膜皮穿支血管连接。基于这些发现，我们设计了一种改良的腓肠远端神经筋膜肌皮瓣，包括腓肠肌远端成分，并用于修复6例下肢远端和足底跟垫软组织缺损。皮瓣的血供包括腓穿支和脂肪筋膜蒂，或仅包括腓穿支，筋膜皮瓣的平均大小为51 cm(2)，肌肉部分为17.7 cm(2)。所有的襟翼都安然无恙。本研究结果为腓肠远端神经筋膜肌皮瓣修复下肢及足跟软组织缺损提供了更广泛的应用前景。(C) 2008 Wiley-Liss, Inc。显微外科29:205-213,2009。
The reconstruction of the distal third leg and weight-bearing heel, especially when complicated with infection and/or dead space, remains a challenge in reconstructive surgery. The distally based sural neurofasciomyocutaneous flap has been proved a valuable tool in repair of the soft tissue defects of those areas. In this report, we present the results of the anatomical study on vascular communication between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle and a modified technique in clinical applications for reconstruction of the soft tissue defects in the distal lower leg and heel. Six lower limbs of fresh cadavers were injected with red gelatin and dissected. A constant vascular connection with average four musculo-fasciocutaneous perforators with diameter 0.2-0.5 mm was identified in the overlapping area between the suprafascial sural neurovascular axis and the deep gastrocnemius muscle. Based on these findings, a modified distally based sural neurofasciomyocutaneous flap including the distal gastrocnemius muscle component was designed and used for repairs of the soft tissue defects in the distal lower limb and plantar heel pad in six patients. The blood supplies of flaps comprised either the peroneal perforator and adipofascial pedicle or the peroneal perforator only The average size of the fasciocutaneous flap was 51 cm(2), and the muscle component 17.7 cm(2). All flaps survived uneventfully. Our results suggest that this technical modification could provide wider range for applications of the distally based sural neurofasciomyocutaneous flap in repair of the soft tissue defects of the lower extremity and heel. (C) 2008 Wiley-Liss, Inc. Microsurgery 29:205-213, 2009.