CAJ | 학술논문

目的：介绍腓肠神经-小隐静脉逆行岛状肌皮瓣的局部血管解剖研究与临床应用经验。方法解剖3个成人小腿灌注标本，观察腓肠神经-小隐静脉血管轴与腓肠肌内外侧头肌支和肌皮穿支之间的吻合关系，根据观察结果设计以腓动脉肌间隔穿支供血的逆行岛状腓肠肌皮瓣修复4例足踝部创面，皮瓣面积10～16 cm ×6～9 cm。结果在腓肠神经穿出深筋膜前，腓肠神经-小隐静脉血管轴与两侧的腓肠肌肌支间各有2～4个吻合。在穿出深筋膜后，与两侧的腓肠肌肌皮穿支间各有2～3个吻合。在腓肠肌腱腹交界（约为小腿中点）的近侧2～4 cm 内，有1～3支肌皮穿支血管与腓肠神经血管轴相交通。据此设计的肌皮瓣完全成活。结论腓肠神经-小隐静脉逆行岛状肌皮瓣血供可靠、转移方便，较传统的腓肠神经营养血管皮瓣可切取面积更大，是修复足踝部组织缺损的好方法。
목적：개소비장신경-소은정맥역행도상기피판적국부혈관해부연구여림상응용경험。방법해부3개성인소퇴관주표본，관찰비장신경-소은정맥혈관축여비장기내외측두기지화기피천지지간적문합관계，근거관찰결과설계이비동맥기간격천지공혈적역행도상비장기피판수복4례족과부창면，피판면적10～16 cm ×6～9 cm。결과재비장신경천출심근막전，비장신경-소은정맥혈관축여량측적비장기기지간각유2～4개문합。재천출심근막후，여량측적비장기기피천지간각유2～3개문합。재비장기건복교계（약위소퇴중점）적근측2～4 cm 내，유1～3지기피천지혈관여비장신경혈관축상교통。거차설계적기피판완전성활。결론비장신경-소은정맥역행도상기피판혈공가고、전이방편，교전통적비장신경영양혈관피판가절취면적경대，시수복족과부조직결손적호방법。
Objective To introduce the regional anatomy of retrograde island musculocutaneous flap pedicled with small saphenous vein and sural nerve nutrition and provide experiences for its clinical application.Methods Three injected adult samples of the lower limb were dissected for identification of anastomoses among the axis of small saphenous vein and sural nerve,the medial and lateral branches of the sural muscle and musculocutaneous branches.Based on these anatomic studies,the retrograde sural island flap(10 ~16 cm ×6 ~9 cm)supported by intermuscular branches of the peroneal artery was transferred for reconstruction of foot and ankle wounds in 4 cases.Results There were 2 ~4 anastomoses connecting the axis of small saphenous vein and sural nerve to the sural muscular branches before sural nerve pierced out of the deep fascia,and 2 ~3 anastomoses were observed after the piercing.Furthermore,at a location 2 ~4 cm proximal to the junction between tendon and belly(the midpoint of the lower limb),there were usually 1 ~3 perforator vessels communicating the sural neurovascular axis.Flaps designed by above standard were all successfully transferred.Conclusion The retrograde island musculocutaneous flap pedicled with small saphenous vein and sural nerve increases incision areas,which is a reliable,versatile and simple method for foot and ankle tissue defects.