穿支蒂足背外侧皮神经浅静脉营养血管皮瓣的解剖基础

Anatomical basis for design of the perforator-pedicled flap with nutritional vessels of the lateral dorsal cutaneous nerve and the lateral vein of the foot

目的为穿支蒂足背外侧皮神经浅静脉营养血管皮瓣修复前足软组织缺损提供解剖基础。方法在30侧动脉内灌注红色乳胶的成人足标本上解剖观测:1足背外侧皮神经/足外侧缘静脉的走行与分布;2足底外侧动脉足背穿支与足背外侧皮神经浅静脉营养血管间吻合关系。另在1侧新鲜标本上进行摹拟手术设计。结果 1足背外侧皮神经外侧支为主干的延续,伴足外侧缘静脉恒定的沿足外侧缘径直前行,分布于足背外侧缘及第5趾外侧缘皮肤;2足背外侧皮神经/足外侧缘静脉营养血管为多节段、多源性,其中足底外侧动脉在第5跖骨与小趾外侧群肌之间浅出的足背穿支位置相对恒定,并分出众多的细小血管与足外侧缘静脉旁血管链的分支密切吻合。结论可形成以足底外侧动脉足背穿支蒂足背外侧皮神经浅静脉营养血管皮瓣转位修复前足软组织缺损。

Objective To provide applied anatomical basis for design of perforator-pedicled flap with nutritional vessels of the lateral dorsal cutaneous nerve and the lateral vein of the foot to reconstruct the soft tissue defects of the forefoot. Methods 30 specimens of adult human feet perfused with red latex have been used. The following contents were observed under surgical magnifier： ①The course and distribution of lateral dorsal cutaneous nerve of the foot, and the lateral vein of foot; ②The anastomoses among the dorsal perforator of lateral plantar artery and the nutritional vessels of the lateral superficial vein and the lateral dorsal cutaneous nerve of the foot. Simulated operation was performed on another fresh specimen. Results ①The lateral dorsal cutaneous nerve of foot was the direct continuation of the trunk, and coursed along with the lateral vein of the foot, innervating lateral aspect of the dorsal foot and the lateral skin of the fifth toe; ② Nutritional vessels of the lateral dorsal cutaneous nerve of the foot and the lateral vein of the foot were of multiple segments and multiple origins. The perforator of the lateral plantar artery was relatively consistent in position, emerging superficially between the fifth metatarsal bone and lateral group of muscles of the fifth phalange. It gave off minute branches to anastomose with longitudinal nutritional vascular plexus of lateral dorsal superficial vein the foot. Conclusion The perforator-pedicled flap with nutritional vessels of the lateral dorsal cutaneous nerve and the lateral vein of the foot can be harvested to repair the defect of soft tissue on forefoot.