皮神经营养血管穿支皮瓣在四肢软组织缺损中的应用
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摘要
皮神经营养血管穿支皮瓣是以起源于深部的穿支血管为蒂,沿皮神经长轴切取皮肤和皮下组织形成的皮瓣,可以带蒂转移,也可以游离移植,具有血供丰富、皮瓣切取范围大、静脉淤血小、成活率高等特点。本文旨在结合相关文献资料,对皮瓣的发展和皮神经营养血管穿支皮瓣的解剖学、优势、血管定位、切取要点和临床应用进行综述。
The neurocutaneous vascular perforator flap is pedicled with perforator vessels originating from the deep and formed by cutting skin and subcutaneous tissue along the long axis of cutaneous nerve, which can be transplanted with pedicle or free transplantation. It has the characteristics of abundant blood supply, large scope of flap incision, small vein congestion and high survival rate. The purpose of this paper is to combine relevant literature information, and review the development of the flap and the anatomy, advantages, vascular localization, key points of excision and clinical application of the neurocutaneous vascular perforator flap.
The neurocutaneous vascular perforator flap is pedicled with perforator vessels originating from the deep and formed by cutting skin and subcutaneous tissue along the long axis of cutaneous nerve, which can be transplanted with pedicle or free transplantation. It has the characteristics of abundant blood supply, large scope of flap incision, small vein congestion and high survival rate. The purpose of this paper is to combine relevant literature information, and review the development of the flap and the anatomy, advantages, vascular localization, key points of excision and clinical application of the neurocutaneous vascular perforator flap.
引文
[1]丁自海,王增涛,钟世镇.皮瓣解剖学研究的三个阶段[J].中华显微外科杂志, 2010, 33(3):180-181.
[2] McGregor IA, Morgan G. Axial and random pattern flaps[J]. Br J Plast Surg, 1973, 26(3):202-213.
[3]钟世镇,孙博,刘牧之,等.皮瓣血供的解剖学类型[J].临床应用解剖学杂志, 1984, 4(2):1-5.
[4]杨果凡,陈宝驹,高玉智.前臂皮瓣游离移植术(附56例报告)[J].中华医学杂志, 1981, 61(3):139-141.
[5]徐永清,林涧,郑和平.穿支皮瓣[M].北京:人民卫生出版社, 2015.
[6] Bertelli J, Khoury Z. Vascularization of lateral and medial eutaneoas nerves of the forearm.Anatomie basis of neuro-cutaneous island flap on the elbow[J]. Surg Radial Anat, 1991, 13(4):345-346.
[7] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves:Anatomic study and clinical experience on the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-1121.
[8]曾国波,鲁勇.腓肠神经营养血管皮瓣修复下肢软组织缺损[J].吉林医学, 2013, 34(3):509.
[9]陈雪松.腓动脉穿支小腿后外侧皮神经营养血管皮瓣的临床应用策略[J].创伤外科杂志, 2017, 19(12):953-956.
[10]张世民,徐达传,张发惠,等.外踝后穿支皮瓣[J].中国临床解剖学杂志, 2005, 23(4):345-348.
[11] HK Kao, KP Chang, YA Chen, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction[J]. Plastic&Reconstructive Surgery, 2010,125(4):1135-1145.
[12]马心赤,邱勋永,王快胜,等.小腿血管穿支蒂皮神经营养血管皮瓣的临床应用[J].中华显微外科杂志, 2007, 30(2):149-151.
[13]段家章,何晓清,徐永清.股前外侧皮瓣血管解剖学及术前皮瓣设计技术研究进展[J].中国修复重建外科杂志,2016,30(7):909-914.
[14]柴益民,林崇正,陈彦堃,等.腓动脉终末穿支蒂腓肠神经营养血管皮瓣的临床应用[J].中华显微外科杂志,2001,24(3):167-169.
[15] Wen G, Wang CY, Chai YM, et al. Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities[J]. Microsurgery, 2013, 33(8):625-630.
[16] Lu S, Wang C, Wen G, et al. Versatility of the reversed superficial peroneal neurocutaneous island flap in the coverage of ankle and foot[J]. Ann Plast Surg, 2015, 74(1):69-73.
[17] Dai J, Chai Y, Wang C, et al. Distally based saphenous neurocutaneous perforator flap for reconstructive surgery in the lower leg and the foot:a long-term follow-up study of 70 patients[J]. J Reconstr Microsurg, 2013, 29(7):481-485.
[18] Lu S, Wang C, Zhong W, et al. Amputation stump revision using a free sural neurocutaneous perforator flap[J]. Ann Plast Surg, 2016, 76(1):83-87.
[19] Wang CY, Chai YM, Wen G, et al. The free peroneal perforatorbased sural neurofasciocutaneous flap:a novel tool for reconstruction of large soft-tissue defects in the upper limb[J]. Plast Reconstr Surg, 2011, 127(1):293-302.
[20] Cai PH, Liu SH, Chai YM, et al. Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm[J]. Chin Med J(Engl), 2009, 122(14):1621-1624.
[21]陈雪松,徐永清,杨黎,等.超薄游离腓动脉穿支皮神经营养血管皮瓣修复手、足皮肤软组织缺损[J].中华创伤杂志, 2017, 33(4):355-361.
[22]陈雪松,徐永清,杨黎,等.游离腓动脉穿支小腿后外侧皮神经营养血管筋膜皮瓣修复足背远端创面[J].中华整形外科杂志, 2017,33(3):191-195.
[23]陈雪松,徐永清,陈建明,等.主穿支皮神经营养血管皮瓣一期修复小腿及足踝部高能损伤创面[J].中华整形外科杂志, 2013,29(2):81-87.
[24]陈雪松,王元山,肖茂明,等.游离穿支腓肠神经营养血管皮瓣修复手背软组织缺损[J].中国修复重建外科杂志, 2009, 23(6):767-768.
[25]李浩,王健,沈永辉,等.骨间后动脉桡侧支穿支蒂前臂后皮神经营养血管皮瓣游离移植修复手指缺损[J].中华显微外科杂志, 2015, 38(5):506-508.
[26]王斌,邵新中,高顺红,等.游离腓动脉远端穿支腓肠神经营养血管皮瓣修复上肢皮肤缺损[J].中华手外科杂志, 2008, 24(6):372-374.
[2] McGregor IA, Morgan G. Axial and random pattern flaps[J]. Br J Plast Surg, 1973, 26(3):202-213.
[3]钟世镇,孙博,刘牧之,等.皮瓣血供的解剖学类型[J].临床应用解剖学杂志, 1984, 4(2):1-5.
[4]杨果凡,陈宝驹,高玉智.前臂皮瓣游离移植术(附56例报告)[J].中华医学杂志, 1981, 61(3):139-141.
[5]徐永清,林涧,郑和平.穿支皮瓣[M].北京:人民卫生出版社, 2015.
[6] Bertelli J, Khoury Z. Vascularization of lateral and medial eutaneoas nerves of the forearm.Anatomie basis of neuro-cutaneous island flap on the elbow[J]. Surg Radial Anat, 1991, 13(4):345-346.
[7] Masquelet AC, Romana MC, Wolf G. Skin island flaps supplied by the vascular axis of the sensitive superficial nerves:Anatomic study and clinical experience on the leg[J]. Plast Reconstr Surg, 1992, 89(6):1115-1121.
[8]曾国波,鲁勇.腓肠神经营养血管皮瓣修复下肢软组织缺损[J].吉林医学, 2013, 34(3):509.
[9]陈雪松.腓动脉穿支小腿后外侧皮神经营养血管皮瓣的临床应用策略[J].创伤外科杂志, 2017, 19(12):953-956.
[10]张世民,徐达传,张发惠,等.外踝后穿支皮瓣[J].中国临床解剖学杂志, 2005, 23(4):345-348.
[11] HK Kao, KP Chang, YA Chen, et al. Anatomical basis and versatile application of the free medial sural artery perforator flap for head and neck reconstruction[J]. Plastic&Reconstructive Surgery, 2010,125(4):1135-1145.
[12]马心赤,邱勋永,王快胜,等.小腿血管穿支蒂皮神经营养血管皮瓣的临床应用[J].中华显微外科杂志, 2007, 30(2):149-151.
[13]段家章,何晓清,徐永清.股前外侧皮瓣血管解剖学及术前皮瓣设计技术研究进展[J].中国修复重建外科杂志,2016,30(7):909-914.
[14]柴益民,林崇正,陈彦堃,等.腓动脉终末穿支蒂腓肠神经营养血管皮瓣的临床应用[J].中华显微外科杂志,2001,24(3):167-169.
[15] Wen G, Wang CY, Chai YM, et al. Distally based saphenous neurocutaneous perforator flap combined with vac therapy for soft tissue reconstruction and hardware salvage in the lower extremities[J]. Microsurgery, 2013, 33(8):625-630.
[16] Lu S, Wang C, Wen G, et al. Versatility of the reversed superficial peroneal neurocutaneous island flap in the coverage of ankle and foot[J]. Ann Plast Surg, 2015, 74(1):69-73.
[17] Dai J, Chai Y, Wang C, et al. Distally based saphenous neurocutaneous perforator flap for reconstructive surgery in the lower leg and the foot:a long-term follow-up study of 70 patients[J]. J Reconstr Microsurg, 2013, 29(7):481-485.
[18] Lu S, Wang C, Zhong W, et al. Amputation stump revision using a free sural neurocutaneous perforator flap[J]. Ann Plast Surg, 2016, 76(1):83-87.
[19] Wang CY, Chai YM, Wen G, et al. The free peroneal perforatorbased sural neurofasciocutaneous flap:a novel tool for reconstruction of large soft-tissue defects in the upper limb[J]. Plast Reconstr Surg, 2011, 127(1):293-302.
[20] Cai PH, Liu SH, Chai YM, et al. Free peroneal perforator-based sural neurofasciocutaneous flaps for reconstruction of hand and forearm[J]. Chin Med J(Engl), 2009, 122(14):1621-1624.
[21]陈雪松,徐永清,杨黎,等.超薄游离腓动脉穿支皮神经营养血管皮瓣修复手、足皮肤软组织缺损[J].中华创伤杂志, 2017, 33(4):355-361.
[22]陈雪松,徐永清,杨黎,等.游离腓动脉穿支小腿后外侧皮神经营养血管筋膜皮瓣修复足背远端创面[J].中华整形外科杂志, 2017,33(3):191-195.
[23]陈雪松,徐永清,陈建明,等.主穿支皮神经营养血管皮瓣一期修复小腿及足踝部高能损伤创面[J].中华整形外科杂志, 2013,29(2):81-87.
[24]陈雪松,王元山,肖茂明,等.游离穿支腓肠神经营养血管皮瓣修复手背软组织缺损[J].中国修复重建外科杂志, 2009, 23(6):767-768.
[25]李浩,王健,沈永辉,等.骨间后动脉桡侧支穿支蒂前臂后皮神经营养血管皮瓣游离移植修复手指缺损[J].中华显微外科杂志, 2015, 38(5):506-508.
[26]王斌,邵新中,高顺红,等.游离腓动脉远端穿支腓肠神经营养血管皮瓣修复上肢皮肤缺损[J].中华手外科杂志, 2008, 24(6):372-374.