Department of Plastic and Reconstructive Surgery, T. N. Medical College (TNMC), Mumbai, India.
Department of Plastic and Reconstructive Surgery, China Medical University Hospital, Taichung, Taiwan.
Microsurgery. 2018 Feb;38(2):157-163. doi: 10.1002/micr.30158. Epub 2017 Jan 23.
Complex lower extremity trauma still poses a formidable challenge for micro vascular reconstruction. The extensive surrounding zone of trauma can make it difficult to find a suitable recipient pedicle for anastomosis. A need was felt for exploration of newer recipient vessels in lower extremity which could be harnessed for reliable and tension free micro anastomosis. The purpose of the present report is to highlight the possibility of using medial sural artery for safe micro vascular anastomosis in selected scenarios like vessel depleted extremity.
Between 2008 and 2013, we used the medial sural vessels for micro anastomosis in 10 cases of lower extremity trauma. All the cases had severe soft tissue trauma with or without a bony defect. A computed tomography angiogram (CTA) of the involved extremity revealed either severe perivascular scarring around the standard recipient vessels or patency of just a single vessel. However, in all cases a patent medial sural pedicle was identified on CTA. Interposition vein grafts (IVGs) were used in most cases to ensure a tension free anastomosis.
In all cases, unscarred medial sural vessels were identified with average dissected length and diameter being 6.2 cm (range 4 to 7.5 cm) and 2 mm (range 1.5 to 2.5 mm) respectively. Vein graft [average length 5.6 cm (range 4 to 15 cm)] was interposed in seven cases, while in remaining three, long saphenous vein was used for vein anastomosis. All the flaps survived after the surgery. There was one re-exploration for evacuation of peri-anastomotic hematoma with no adverse effect on flap survival. The mean follow up period was 27.6 months. In the four cases with bone reconstruction, bony union was seen between 5 and 8 months. They were able to walk without aids and resume work after 10-14 months, following a structured rehabilitation program. The patients with soft tissue reconstruction (6 cases) could carry out aid free locomotion and resume their routine after 4-6 weeks. There were no long term complications in any of the flap.
Medial sural artery may prove to be a reliable recipient pedicle for use in complex lower extremity trauma cases and could possibly provide a safer alternative in cases with severe perivascular scarring or in a "single vessel" extremity.
复杂的下肢创伤仍然对微血管重建构成了巨大的挑战。广泛的创伤周围区域使得寻找合适的吻合受体蒂变得困难。人们需要探索下肢新的受体血管，以便进行可靠和无张力的微血管吻合。本报告的目的是强调在特定情况下，如血管耗竭的肢体，可以使用腓肠内侧动脉进行安全的微血管吻合。
在 2008 年至 2013 年间，我们在 10 例下肢创伤患者中使用腓肠内侧血管进行微血管吻合。所有病例均有严重的软组织创伤，伴有或不伴有骨缺损。受累肢体的计算机断层血管造影（CTA）显示标准受体血管周围有严重的血管周围瘢痕，或仅一条血管通畅。然而，在所有病例中，CTA 均显示腓肠内侧蒂通畅。大多数情况下，使用静脉移植物（IVG）以确保无张力吻合。
在所有病例中，均发现无瘢痕的腓肠内侧血管，平均解剖长度和直径分别为 6.2 厘米（范围 4 至 7.5 厘米）和 2 毫米（范围 1.5 至 2.5 毫米）。在 7 例中插入了静脉移植物（平均长度 5.6 厘米，范围 4 至 15 厘米），而在其余 3 例中，使用大隐静脉进行静脉吻合。手术后所有皮瓣均存活。有 1 例因吻合口周围血肿而再次探查，无皮瓣存活不良。平均随访时间为 27.6 个月。在 4 例有骨重建的病例中，5 至 8 个月后可见骨愈合。他们在接受结构化康复计划后，能够在没有辅助的情况下行走并在 10-14 个月后恢复工作。在 6 例软组织重建的病例中，患者在 4-6 周后能够无辅助活动并恢复正常生活。所有皮瓣均无长期并发症。
腓肠内侧动脉可能成为复杂下肢创伤病例中可靠的受体蒂，在严重血管周围瘢痕或“单血管”肢体的情况下，可能提供更安全的选择。
