腓肠内侧血管的解剖学研究与临床应用

摘要

目的 探讨腓肠内侧血管的解剖学特点及其供血游离皮瓣的临床疗效.方法 选用新鲜成人下肢标本6侧,行乳胶灌注后,解剖观察腓肠肌的供血动脉起点,测量动、静脉数量及腓肠内侧血管肌外部分长度、外径.回顾性分析2009年7月至2013年5月收治的15例小腿严重皮肤软组织缺损患者临床资料,皮肤缺损面积13 cm×7 cm～24 cm×12 cm,以腓肠内侧血管为受区血管蒂,10例选取股前外侧游离皮瓣修复创面,5例选取背阔肌游离皮瓣修复,供区直接缝合或游离植皮.结果 解剖研究发现腓肠肌为多源性供血,腓肠内、外侧动脉起自腘动脉,腓肠内侧血管为1条动脉、2条静脉,肌外长度4～7 cm,平均5.4 cm,动脉起点外径2.6～2.9 mm,平均2.7 mm,入肌处外径1.9～2.3 mm,平均2.1 mm.静脉注入腘静脉处外径2.7～3.4 mm,平均2.9 mm,入肌处外径1.8～2.2 mm,平均2.0 mm.15例皮瓣全部成活,创面均一期愈合.术后随访11～21个月,平均16.5个月,皮瓣外形满意,质地柔软,弹性好,恢复保护性感觉,患者对术后效果满意.结论 腓肠内侧血管解剖位置恒定,位置深,损伤几率小,蒂长,适于吻合,应用其为游离皮瓣供血,修复小腿大面积皮肤缺损,效果满意.%Objective To study the anatomical characteristics of the medial sural vessels and the clinical effects of treatment for leg skin and soft tissue defect with free flaps.Methods 6 adult lower limbs were treated by latex perfusion and then observed the origin of the blood supply to gastrocnemius muscle,measure the number of the arteries and veins,the length and diameter of the medial sural vessels.From July 2009 to May 2013,15 clinical cases of serious skin and soft tissue defect were repaired by using free flap with medial sural vessels.The areas of wound surface were ranging from 13 cm × 7 cm-24 cm × 12 cm.10 of them were treated by anterolateral thigh flap,the other of them were treated by latissimus dorsi flap.The donor site were directly sutured or repaired by free skin graft.Results The blood supply of gastrocnemius mucle was multifocal.The medial sural arteries and lateral sural arteries were both origin from popliteal artery.The medial sural vessels include 1 artery and 2 veins.With the length 4-7 cm (average,5.4 cm),the arterial diameter of the origin 2.6-2.9 mm (average,2.7 mm) and the entry point 1.9-2.3 mm (average,2.1 mm),the vein diameter of the origin 1.8-2.2 mm (average,2.0 mm)and the entry point 2.7-3.4 mm(average,2.9 mm).Totally 15 cases flaps were survived with primary healing.The mean follow-up period was 16.5 months(range,11-21 months),The flaps had satisfactory appearance,soft texture,good elasticity and achieved protective sensation at the last followed-up.Conclusions The medial sural vessels are with constant anatomical position,deeply position,hardly damage,long pedicle.Thus,the medial sural vessels combine with free flap is an good choice for the reconstruction of leg skin and soft tissue defect.