Hallock G G
Division of Plastic Surgery, The Lehigh Valley Hospitals, Allentown, PA, USA.
Ann Plast Surg. 2001 Nov;47(5):517-22. doi: 10.1097/00000637-200111000-00008.
The gastrocnemius muscle is rarely considered today as a musculocutaneous flap. Yet, the posterior calf skin by itself can still be used to advantage as a source of local or perhaps free flaps. Fascial perforators in this region were reexamined in an anatomic study in 10 fresh cadaveric specimens to investigate the possibility of a gastrocnemius muscle perforator-based flap. At least two substantive perforators were found in all limbs, and there was always one overlying the medial gastrocnemius muscle (overall mean, 4.0 +/- 1.8 perforators; range, 2-7 perforators). The origin of these perforators in any given specimen was most commonly as a secondary branch from the medial or lateral sural arteries alone (60%), from the median sural artery as a direct cutaneous branch alone (10%), or from either of the muscle pedicles and/or the median sural artery (30%). Thus, in 90% of limbs, the potential for elevating a gastrocnemius perforator-based flap exists without the need for any muscle sacrifice. Otherwise, a more traditional posterior calf fasciocutaneous flap was possible. Other deeper intramuscular collaterals were also identified so that sequential use of the muscle as a separate flap does not seem to be compromised.
如今，腓肠肌很少被视为肌皮瓣。然而，小腿后侧皮肤本身仍可作为局部或游离皮瓣的良好供区。在一项解剖学研究中，对10具新鲜尸体标本的该区域筋膜穿支进行了重新检查，以研究基于腓肠肌穿支的皮瓣的可能性。在所有肢体中均发现至少两条实质穿支，且总是有一条位于腓肠肌内侧上方（总体均值为4.0±1.8条穿支；范围为2 - 7条穿支）。在任何给定标本中，这些穿支的起源最常见的是单独作为腓肠内侧或外侧动脉的二级分支（60%），单独作为腓肠中动脉的直接皮支（10%），或来自肌蒂和/或腓肠中动脉中的任何一个（30%）。因此，在90%的肢体中，无需牺牲任何肌肉即可掀起基于腓肠肌穿支的皮瓣。否则，可采用更传统的小腿后侧筋膜皮瓣。还发现了其他更深层的肌内侧支，因此依次将肌肉作为单独的皮瓣使用似乎不会受到影响。
