Chen Xue-song, Xu Yong-qing, Xiao Mao-ming, Wang Yuan-shan, Ma Zhi-xian, Guan Li, Zhang Li-ming, Jiang Min
Department of Microsurgery and Trauma, Microsurgery Centre of Chendu Military Region, No. 59 Military Hospital, Kaiyuan 661600, China.
Zhonghua Zheng Xing Wai Ke Za Zhi. 2010 Nov;26(6):417-21.
To study the distribution of the dominant perforators (the diameter > or = 0.8 mm) of the peroneal artery with color Doppler flow imaging (CDFI) for the purpose of anatomical preparations for the perforator sural neurocutaneous flap.
The dominant perforators of the peroneal artery (DPPA) were studied with CDFI on bilateral legs of 20 healthy volunteers. The numbers, diameters and locations of the perforators were recorded for a statistical analysis. From Jan. 2005 to Jan. 2009, 51 free or pedicled sural neurocutaneous flaps supplied by a single DPPA were designed and harvested to repair the defects near the ankle (n=22), at the leg (n=15) and the forefoot or hand dorsum (n=14). The perforators were located preoperatively with CDFI and accuracy of CDFI was evaluated intraoperatively. The causes of false results were analysed to improve examining techniques.
The average number of DPPA was 4.2 with the average diameter of (1.13 +/- 0.24) mm (0.80-1.90 mm). They were located in the second to ninth segment of the line from the fibular caput to the tip of lateral malleolus which was equally divided into nine segments. The largest DPPA was (1.43 +/- 0.29) mm (1.00-1.90 mm) in diameter and most of them were located in the third to fifth segment (80.4%). The average diameter of the lowest DPPA was (1.02 +/- 0.16) mm( 0.80-1.30 mm) and they were located between the sixth to ninth segment. The total 169 DPPA as well as the largest ones mostly appeared in the middle third of the leg. All of the 51 flaps were transplanted successfully without necrosis, and no vascular problems occurred. Preoperative CDFI examination had a 93.6% true-positive rate and an 88.0% positive predictive value. What should be demonstrated was that if just considered the cases after Dec. 2007, the true-positive rate was 97%, and the positive predictive value was 93.9%.
According to the distribution characteristics of DPPA, a sural neurocutaneous flap pedicled with one of this relatively large perforator can be designed and harvested to repair skin defects of leg and around ankle, but can not be utilized for that of forefoot. With anastomosis of the perforator, the flap based on the largest DPPA can be used as a free flap to cover defect anywhere. CDFI is reliable in preoperative location of DPPA, which makes the surgical procedures easier.
采用彩色多普勒血流成像（CDFI）研究腓动脉优势穿支（直径≥0.8mm）的分布情况，为穿支腓肠神经营养血管皮瓣的解剖学制备提供依据。
应用CDFI对20例健康志愿者双侧下肢的腓动脉优势穿支进行研究，记录穿支的数量、直径及位置，并进行统计学分析。2005年1月至2009年1月，设计并切取以单支腓动脉优势穿支为蒂的游离或带蒂腓肠神经营养血管皮瓣51例，修复踝关节附近缺损22例、小腿缺损15例、足背或手背缺损14例。术前应用CDFI定位穿支，并于术中评估CDFI的准确性，分析误诊原因以改进检查技术。
腓动脉优势穿支平均数量为4.2支，平均直径为（1.13±0.24）mm（0.80～1.90mm）。穿支位于自腓骨头至外踝尖连线的第2～9段，该连线等分为9段。最大穿支直径为（1.43±0.29）mm（1.00～1.90mm），多位于第3～5段（80.4%）。最下端穿支平均直径为（1.02±0.16）mm（0.80～1.30mm），位于第6～9段。169支腓动脉优势穿支及最大穿支大多位于小腿中1/3。51例皮瓣均移植成功，无坏死，未发生血管相关问题。术前CDFI检查真阳性率为93.6%，阳性预测值为88.0%。需说明的是，若仅考虑2007年12月以后的病例，真阳性率为97%，阳性预测值为93.9%。
根据腓动脉优势穿支的分布特点，可设计切取以较粗大穿支之一为蒂的腓肠神经营养血管皮瓣修复小腿及踝关节周围皮肤缺损，但不适用于足背皮肤缺损。通过吻合穿支，以最大腓动脉优势穿支为蒂的皮瓣可制成游离皮瓣修复任意部位缺损。CDFI对腓动脉优势穿支的术前定位可靠，可简化手术操作。
