Maffi Terry R, Knoetgen James, Turner Norman S, Moran Steven L
Department of Plastic Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Plast Surg. 2005 Mar;54(3):302-5.
The reverse sural artery flap is frequently used for reconstruction of the distal third of the leg, ankle, and heel. The major disadvantage of the flap is compression of the pedicle within the subcutaneous tunnel and venous congestion. Others have cited a decrease in this problem by harvesting a midline cuff of gastrocnemius muscle, including more subcutaneous tissue and using a wider-than-usual pedicle. We describe an interpolation flap technique of simply avoiding a subcutaneous tunnel and exteriorizing the pedicle with no other alterations to flap design or elevation techniques. Seven distally based reverse sural artery flaps were performed on ambulatory patients between 2001 and 2002. Venous congestion did not occur in any of the flaps. All patients were ambulatory after surgery and did not require the use of a custom shoe. We conclude that transferring the flap in 2 stages without the use of a tunnel improves the reliability of the flap and eliminates venous congestion.
逆行腓肠神经营营瓣常用于小腿远侧1/3、踝部及足跟的重建。该皮瓣的主要缺点是皮下隧道内蒂部受压及静脉淤血。其他人通过切取含更多皮下组织的腓肠肌中线袖状组织并使用比通常更宽的蒂部，指出该问题有所减少。我们描述了一种插入皮瓣技术，即简单地避免皮下隧道并将蒂部外置，而对皮瓣设计或掀起技术不做其他改变。2001年至2002年间，对7例门诊患者实施了7个远端蒂逆行腓肠神经营营瓣。所有皮瓣均未发生静脉淤血。所有患者术后均能行走，且无需使用定制鞋。我们得出结论，分两期转移皮瓣且不使用隧道可提高皮瓣的可靠性并消除静脉淤血。
