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目的探讨腓浅神经营养血管为蒂的肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎的解剖学依据及其临床应用效果。方法对30侧成人下肢灌注标本进行解剖,系统观测腓浅神经及其营养血管的来源、走行、分布、吻合及外径;3侧成人新鲜下肢标本墨汁灌注,观测腓浅神经营养血管的墨染范围;在此基础上,自2009年6月以来,应用远端蒂腓浅神经营养血管肌皮瓣修复小腿远端及足踝部皮肤软组织缺损伴骨缺损慢性骨髓炎者12例。结果腓浅神经营养血管发自胫前动脉穿支,其血管在其神经束间及神经旁相互吻合构成丰富的血管网,并借分支与皮下筋膜血管网沟通,并与腓骨长肌、趾长伸肌的肌支有恒定的吻合,营养筋膜皮肤。12例肌皮瓣的肌肉面术中可见渗血活跃,血供良好,皮瓣均成活,术后3~6个月随访12例肌皮瓣均存活,慢性骨髓炎治愈,外形满意。结论腓浅神经营养血管的肌皮瓣转位修复小腿远端及足踝部特殊创面是较佳的选择,该肌皮瓣具有血供可靠,预后良好等优点。
Objective To investigate the anatomic basis and clinical application of myocutaneous flap pedicled with peroneal nerve nutrient vessels in the repair of chronic osteomyelitis of the skin and soft tissue defects of the lower extremity and ankle and ankle. Methods 30 adult adult lower extremity perfusion specimens were dissected and the origin, course, distribution, anastomosis and external diameter of the superficial peroneal nerve and its nutrient vessels were systematically observed. The ink perfusion of 3 adult fresh lower extremities was observed, On this basis, since June 2009, 12 cases of chronic osteomyelitis with defect of bone and soft tissue defect at distal and ankle of calf were repaired with distal pedicel and superior nerve nutrient vessel myocutaneous flap. Results The peroneal neurovascular vessels originated from the anterior tibial artery perforating branches. The blood vessels in the intervertebral nerve and nerve tissues matched each other to form a rich vascular network. The vessels were connected to the subcutaneous fascia vascular network and communicated with the peroneus longus muscle, Long extensor muscle branch consistent with a constant, nutrition fascia skin. 12 cases of myocutaneous flap muscle surgery showed active bleeding, blood supply is good, the flaps are alive, 3 to 6 months after follow-up of 12 cases of myocutaneous flap survival, chronic osteomyelitis cure, shape satisfactory. Conclusion Transposition of myocutaneous flap of superficial peroneal neurovascular vessels is a better choice for the repair of distal and ankle special wounds. The myocutaneous flap has the advantages of reliable blood supply and good prognosis.