CAJ | 학술논문

目的：探讨腓肠血管的解剖学特性及其联合游离皮瓣修复小腿大段组织缺损的临床疗效。方法实验研究：10具新鲜成人尸体标本，随机选择4具，每具结扎一侧肢体腓肠内侧动脉，另4具结扎腓肠外侧动脉，对侧肢体不结扎作为对照，对标本进行血管造影，观察结扎一侧腓肠内或腓肠外动脉后，该侧腓肠肌的血液供应；另外2具通过解剖学及小腿铸型标本观察该侧腓肠肌的血管交通支的来源、管径及部位。临床研究：回顾性分析2006年10月至2013年9月收治的19例小腿大段组织缺损患者资料，男11例，女8例；年龄10～40岁，平均32岁。其中12例采用腓肠内侧血管、7例采用腓肠外侧血管为受区血管，同时6例取游离胸脐皮瓣移植、8例取大腿前外侧皮瓣移植、2例取侧胸皮瓣移植、3例取背阔肌皮瓣移植修复组织缺损。创面面积为5 cm×10 cm～8 cm×37 cm，切取皮瓣面积为7 cm×10 cm～10 cm×30 cm。结果实验研究发现，小腿腓肠肌的血供为多源性，以腓肠动脉供血为主；当切断一侧腓肠血管时，来自腓肠肌内、外侧头之间的交通支和来自比目鱼肌交通支的血液供应该侧腓肠肌，且交通支管径粗、分支多、位置恒定。临床研究显示19例游离皮瓣全部成活，创面愈合时间13～29 d，其中一期愈合11例，二期愈合8例。随访时间12～24个月，皮瓣能耐受一定程度摩擦，均无明显感觉障碍。供区取自体腹部或大腿中厚皮片植皮覆盖，均一期愈合。结论腓肠血管位于腓肠肌深层，位置恒定，蒂长、易分离，管径较粗，适于吻合，腓肠血管联合游离皮瓣为小腿大段组织缺损修复提供一种新的治疗方法。
목적：탐토비장혈관적해부학특성급기연합유리피판수복소퇴대단조직결손적림상료효。방법실험연구：10구신선성인시체표본，수궤선택4구，매구결찰일측지체비장내측동맥，령4구결찰비장외측동맥，대측지체불결찰작위대조，대표본진행혈관조영，관찰결찰일측비장내혹비장외동맥후，해측비장기적혈액공응；령외2구통과해부학급소퇴주형표본관찰해측비장기적혈관교통지적래원、관경급부위。림상연구：회고성분석2006년10월지2013년9월수치적19례소퇴대단조직결손환자자료，남11례，녀8례；년령10～40세，평균32세。기중12례채용비장내측혈관、7례채용비장외측혈관위수구혈관，동시6례취유리흉제피판이식、8례취대퇴전외측피판이식、2례취측흉피판이식、3례취배활기피판이식수복조직결손。창면면적위5 cm×10 cm～8 cm×37 cm，절취피판면적위7 cm×10 cm～10 cm×30 cm。결과실험연구발현，소퇴비장기적혈공위다원성，이비장동맥공혈위주；당절단일측비장혈관시，래자비장기내、외측두지간적교통지화래자비목어기교통지적혈액공응해측비장기，차교통지관경조、분지다、위치항정。림상연구현시19례유리피판전부성활，창면유합시간13～29 d，기중일기유합11례，이기유합8례。수방시간12～24개월，피판능내수일정정도마찰，균무명현감각장애。공구취자체복부혹대퇴중후피편식피복개，균일기유합。결론비장혈관위우비장기심층，위치항정，체장、역분리，관경교조，괄우문합，비장혈관연합유리피판위소퇴대단조직결손수복제공일충신적치료방법。
Objective To study the anatomical characteristics of sural blood vessel, and to explore the clinical effect of sural blood vessel combined with free skin flap in repairing large tissue defect of calf. Methods 10 fresh adult cadavers were col-lected for experimental studies. Chose 8 cadavers randomly and ligate the sural medial vessel (4 cases) or sural lateral vessel (4 cases) of one limb, leaving the contralateral limb un-ligated as control. Angiography was performed to observe the blood supply of the gastrocnemius muscle after the ligation of the sural medial vessel or sural lateral vessel. For the remaining 2 cadavers, the ori-gin, diameter, and location of the communicating branch of the gastrocnemius muscle were observed by macroscopic anatomy and vascular cast. The data of 19 patients with large tissue defect of calf from October 2006 to September 2013 were analyzed retro-spectively for clinical research. There were 11 males and 8 females aged from 10-40 years (mean, 32 years). 12 patients took sural medial blood vessels as recipient vessels, and 7 patients took sural lateral blood vessels. 6 patients were grafted with free chest na-vel flaps, 8 with anterolateral thigh flap, 2 with lateral thoracic flap, and 3 with latissimus dorsi flap. The areas of wound surface were ranging from 5 cm×10 cm-8 cm×37 cm. The areas of the flap dissected were ranging from 7 cm×10 cm-10 cm×30 cm. Re-sults The study found that the blood supply of gastrocnemius muscle of the calf was multifocal, and was mainly by sural artery. When the blood supply of sural artery was cut off from one side, the gastrocnemius muscle could be supplied by the communicat-ing branches between medial and lateral head of gastrocnemius muscle and the communicating branches of soleus muscle. The communicating branches were at constant anatomical locations, with larger diameter and rich branches. All the 19 cases of free skin flip transplantation were survived. Healing time of wound was ranging from 13-29 d, among which 11 cases were primary healing, and 8 were secondary healing. The follow-up duration was ranging from 12-24 months. The flaps could endure friction of certain degree. No sensory dysfunction was reported. For the cases that split thick skin graft or split-thickness thin skin flap taken from abdomen or huckle were autografted to cover the donor site, primary healing was all gained. Conclusion The sural blood vessels are deeply located in the gastrocnemius muscle at constant anatomical locations, with a long pedicle and a large diameter, and are easy to be dissected, thus they are suited for anastomosis. Sural vessel combined with free skin flip provides a new treat-ment option for the repair of large tissue defect of calf.