Shimizu Fumiaki, Kato Aiko, Sato Haruaki, Taneda Hiroko
Department of Plastic Surgery, Oita University, Oita, Japan.
Microsurgery. 2009;29(4):253-8. doi: 10.1002/micr.20626.
Three kinds of free fasciocutaneous flap from the posterior calf region have been described in the literature: the medial sural perforator flap, the lateral sural perforator flap, and the traditional posterior calf fasciocutaneous flap that is supplied by superficial cutaneous vessels. Moreover, it has been reported that superficial cutaneous vessels are of a suitable size for microanastomosis when deep musculocutaneous perforators are absent or relatively tiny. To establish a safe technique for free fasciocutaneous flap elevation from the posterior calf region, we examined the number and location of the musculocutaneous perforators and the size of superficial cutaneous vessels at their origin from the popliteal artery in six formalinized cadavers. We found that all legs had at least one perforator either from the medial sural artery or the lateral sural artery. By contrast, we failed to find superficial cutaneous vessels of suitable size for microanastomosis in three legs, and there was no significant inverse relationship between the diameter of the superficial cutaneous artery and the number of musculocutaneous perforators. Our results suggest that the medial sural perforator flap and the lateral sural perforator flap might be the surgeon's first and second choice, respectively. The traditional posterior calf fasciocutaneous flap should be the third choice because our study suggests that its availability is doubtful. Another site is recommended, when preoperative Doppler study suggests that the existence of musculocutaneous perforator is in doubt. Two clinical cases, with a medial sural perforator flap and a lateral sural perforator flap, respectively, are presented.
腓肠内侧穿支皮瓣、腓肠外侧穿支皮瓣以及由浅静脉血管供血的传统小腿后侧筋膜皮瓣。此外，有报道称，当深部肌皮穿支不存在或相对较小时，浅静脉血管的大小适合进行显微吻合。为了建立一种从小腿后侧区域游离掀起筋膜皮瓣的安全技术，我们在6具福尔马林固定的尸体上检查了肌皮穿支的数量和位置，以及浅静脉血管在腘动脉起始处的大小。我们发现，所有下肢至少有一支来自腓肠内侧动脉或腓肠外侧动脉的穿支。相比之下，我们在三条下肢中未能找到适合显微吻合的浅静脉血管，并且浅静脉动脉直径与肌皮穿支数量之间没有显著的负相关关系。我们的结果表明，腓肠内侧穿支皮瓣和腓肠外侧穿支皮瓣可能分别是外科医生的第一和第二选择。传统小腿后侧筋膜皮瓣应作为第三选择，因为我们的研究表明其可用性存疑。当术前多普勒检查提示肌皮穿支的存在存疑时，建议选择其他部位。本文展示了两例临床病例，分别采用了腓肠内侧穿支皮瓣和腓肠外侧穿支皮瓣。
