Malokov S, Casanova D, Magalon G, Branchereau A
Angiomicrosurgical Department, St. Petersburg State Medical Academy, Litovskaia Street 2, 194100, St. Petersburg, Russia.
Surg Radiol Anat. 2003 Nov-Dec;25(5-6):372-8. doi: 10.1007/s00276-003-0141-y. Epub 2003 Jul 18.
Obliterating arteriopathy of the lower limbs is a classic contraindication for neurocutaneous islands flaps, particularly the sural flap. But recent literature reports examples of its successful application in arteritic patients. The aim of this work was to study the vascular anatomy of the sural flap in patients suffering from arteriopathy and its possible clinical application. Twenty-four specimens of leg amputation were studied. The mean age of the amputated patients was 68.5 years. The clinical signs of arteriopathy had been present for 3-16 years. In 10 cases amputation was carried out directly, in 14 cases after failed revascularization. The results of the dissection showed the theoretical possibility of a sural flap in almost all the cases (23 of 24) despite certain anatomical peculiarities. In the upper part of the leg the arterial network of the sural communicating nerve dominates that of the sural nerve; this should allow the use of a sural flap centered on this vascular axis. In the lower part, the arterial network of the sural communicating nerve is sustained by the perforators of the peroneal artery, then by the branches of the calcaneal artery, and finally by the lateral tarsal artery, which should allow the use of a sural flap with a very distal pedicle. The authors propose a theory which suggests that the progressive evolution of arteriopathy and the concomitant development of a supply network involving the vascularization of the sensory nerves induces the "anticipation" of a sural flap.
下肢闭塞性动脉病是神经皮岛状皮瓣，尤其是腓肠神经营养血管皮瓣的经典禁忌证。但近期文献报道了其在动脉炎患者中成功应用的实例。本研究的目的是探讨患有动脉病患者的腓肠神经营养血管皮瓣的血管解剖结构及其可能的临床应用。研究了24例小腿截肢标本。截肢患者的平均年龄为68.5岁。动脉病的临床症状已存在3 - 16年。10例为直接截肢，14例为血管重建失败后截肢。解剖结果显示，尽管存在某些解剖学特点，但几乎所有病例（24例中的23例）理论上都有可能采用腓肠神经营养血管皮瓣。在小腿上部，腓肠交通神经的动脉网比腓肠神经的动脉网占优势；这使得可以采用以该血管轴为中心的腓肠神经营养血管皮瓣。在小腿下部，腓肠交通神经的动脉网由腓动脉穿支供血，然后由跟骨动脉分支供血，最后由跗外侧动脉供血，这使得可以采用蒂非常靠下的腓肠神经营养血管皮瓣。作者提出了一种理论，认为动脉病的渐进性演变以及伴随的涉及感觉神经血管化的供血网络的发展诱导了腓肠神经营养血管皮瓣的“预期”。
