Li Zelong, Ding Zihai, Wang Peixin, Xie Yibo, Zeng Bo
Department of Orthopedics and Traumatology, No. 188 Hospital of PLA, Chaozhou Guangdong 521000, P R China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006 Mar;20(3):259-63.
To provide the anatomic basis for defect repair of the knee, leg, foot and ankle with great saphenous veno-saphenous neurocutaneous vascular island flaps.
The origin, diameter, branches, distribution and anastomoses of the saphenous artery and saphenous neurocutaneous vascular were observed on 20 sides of adult leg specimens and 4 fresh cadaver voluntary legs. Another 4 fresh cadaver voluntary legs were radiographed with a soft X-ray system after the intravenous injection of Vermilion and cross-sections under profound fascial, other hand, micro-anatomic examination was also performed in these 4 fresh cadaver legs. The soft tissue defects in lower extremity, upper extremity, heel or Hucou in hand were repaired with the proximal or distal pedicle flaps or free flaps in 18 patients (12 males and 6 females,aging from 7 to 53 years). The defect was caused by trauma, tumour, ulcer and scar. The locations were Hucou (1 case), upper leg (3 cases), lower extremity and heal (14 cases). Of then, 7 cases were complicated by bone exposure, 3 cases by tendon exposure and 1 case by steel espouse, the defect size were 4 cm x 4 cm to 7 cm x 13 cm. The flap sizes were 4 cm x 6 cm to 8 cm x 15 cm, which pedicle length was 8-11 cm with 2.5-4.0 cm fascia and 1-2 cm skin at width.
Genus descending genicular artery began from 9.33 +/- 0.81 cm away from upper the condyles medialis, it branched saphenous artery accompanying saphenous nerve descendent. And saphenous artery reached the surface of the skin 7.21 +/- 0.82 cm away from lower the condyles medialis, and anastomosed with the branches of tibialis posterior artery, like "Y" or "T" pattern. The chain linking system of arteries were found accompanying along the great saphenous vein as saphenous nerve, and then a axis blood vessel was formed. The small artery of only 0.05-0.10 mm in diameter, distributed around the great saphenous vein within 5-8 mm and arranged parallelly along the vein like water wave in soft X-ray film. All proximal flaps, distal pedicle flaps and free flaps survived well. The appearance, sensation and function were satisfactory in 14 patients after a follow-up of 6-12 months.
The great saphenous vein as well as saphenous neurocutaneous has a chain linking system vascular net. A flap with the vascular net can be transplanted by free, by reversed pedicle, or by direct pedicle to repair the wound of upper leg and foot. A superficial vein-superficial neurocutaneous vascular flap with abundance blood supply and without sacrificing a main artery is a favourite method in repair of soft tissue defects in foot and lower extremity.
为应用大隐静脉-隐神经营养血管岛状皮瓣修复膝、小腿、足和踝部组织缺损提供解剖学依据。
在20侧成人下肢标本及4侧新鲜尸体志愿下肢上，观测隐动脉、隐神经营养血管的起始、直径、分支、分布及吻合情况。另取4侧新鲜尸体志愿下肢，静脉注射朱砂后用软X线系统摄片，并作深筋膜下断层解剖及显微解剖学观察。应用近端蒂、远端蒂皮瓣或游离皮瓣修复18例患者（男12例，女6例，年龄7～53岁）的下肢、上肢、足跟或手部虎口处软组织缺损。缺损原因包括创伤、肿瘤、溃疡及瘢痕。部位：虎口处1例，大腿上段3例，下肢及足跟14例。其中7例合并骨外露，3例合并肌腱外露，1例合并钢钉外露，缺损面积4cm×4cm～7cm×13cm。皮瓣面积4cm×6cm～8cm×15cm，蒂长8～11cm，蒂宽含筋膜2.5～4.0cm，皮肤1～2cm。
膝降属支动脉于内髁上9.33±0.81cm处起始，发出隐动脉伴隐神经下行，隐动脉于内髁下7.21±0.82cm处浅出至皮下，与胫后动脉分支吻合，呈“Y”形或“T”形。沿大隐静脉有动脉链状吻合系统伴隐神经走行，形成一条轴心血管。直径仅0.05～0.10mm的小动脉，在大隐静脉周围5～8mm范围内分布，在软X线片上呈沿静脉平行排列的水波状。所有近端蒂皮瓣、远端蒂皮瓣及游离皮瓣均成活良好。随访6～12个月，14例患者外观、感觉及功能满意。
大隐静脉及隐神经营养血管存在链状吻合系统血管网。带该血管网的皮瓣可游离移植、逆行带蒂移植或顺行带蒂移植，用于修复大腿上段及足部创面。带浅静脉-浅神经营养血管皮瓣血供丰富，不牺牲主要动脉，是修复足部及下肢软组织缺损的理想方法。
