Sanger James R, Kao Dennis S, Hackbarth Donald A
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):e280-2. doi: 10.1016/j.bjps.2007.12.013. Epub 2008 Jan 28.
Lateral gastrocnemius muscle flaps are reliable flaps routinely used to cover defects in the lower thigh, the knee, and the upper third of the tibia. Peroneal neuropathy following lateral gastrocnemius flap has been described previously and mostly attributed to intraoperative nerve injury. However, compression of the nerve by the flap itself has not been reported. A 56-year-old female developed right common peroneal nerve palsy 10 months after a lateral gastrocnemius flap rotation for knee prosthesis coverage. Surgical exploration found a common peroneal nerve neuroma under a compressive band formed by the lateral fascial edge of the rotated gastrocnemius muscle. The motor nerve of the flap was not denervated. When stimulated, muscle contracted and compressed the common peroneal nerve underneath. Excision of the lateral fascia and selective motor denervation were performed. Postoperatively, the patient's symptoms improved. To prevent compressive common peroneal neuropathy from lateral gastrocnemius rotational flaps, we recommend fascial excision from the lateral aspect of the muscle and selective motor denervation.
腓肠肌外侧头肌瓣是常用于覆盖大腿下部、膝关节和胫骨上三分之一处缺损的可靠肌瓣。此前已有关于腓肠肌外侧头肌瓣术后腓总神经病变的描述，且大多归因于术中神经损伤。然而，尚未有该肌瓣本身压迫神经的报道。一名56岁女性在采用腓肠肌外侧头肌瓣转移术覆盖膝关节假体10个月后出现右侧腓总神经麻痹。手术探查发现，在旋转的腓肠肌外侧筋膜边缘形成的压迫带下有腓总神经神经瘤。肌瓣的运动神经未发生失神经支配。刺激时，肌肉收缩并压迫其下方的腓总神经。遂进行外侧筋膜切除术及选择性运动神经去神经支配术。术后，患者症状改善。为防止腓肠肌旋转肌瓣导致压迫性腓总神经病变，我们建议从肌肉外侧进行筋膜切除及选择性运动神经去神经支配。
