足底部邻近带蒂穿支筋膜皮瓣的解剖基础与临床应用

Anatomic feature of the adjacent perforator fasciocutaneous flap of plantar and its clinical application

目的探讨足底部邻近带蒂穿支筋膜皮瓣修复足底中、小面积缺损的解剖学基础并观察其临床效果。方法从2010年10月至2017年12月，进行两方面工作：①取动脉红色乳胶灌注成人下肢标本5具.在放大镜下，观测足底邻近带蒂穿支筋膜皮瓣血供来源，游标卡尺测量穿支血管管径。⑦在解剖学基础上设计邻近带蒂穿支筋膜皮瓣修复足底皮肤及皮下软组织缺损创面11例.其中恶性黑色素瘤5例，黑痣1例，难治性创面5例。修复缺损范围为1.5cm×2.0cm^4.0cm×5.0cm.皮瓣相应的切取范围为7.0cm×3.0cm～13.0cm×7.0cm。定期进行随访。结果解剖研究发现足底邻近穿支蒂筋膜皮瓣供血管均为足底内侧动脉.外径大于或等于0.5mm穿支数约为7条.平均外径为（0.85~0.19）mm.足底内侧动脉沿走行方向发出多个小分支并在足弓部形成吻合支，保证皮瓣的血供。11例邻近穿支蒂筋膜皮瓣均成活，其中1例远端切口小面积坏死，经换药后愈合。术后有10例经6~24个月随访，足部行走正常,皮瓣质地饱满。无局部疼痛。结论根据足底缺损的大小设计相应的邻近带蒂穿支筋膜皮瓣,皮瓣皮肤质地与缺损区相似,抗压性与耐磨性强,局部创伤小，无新供区损伤,是修复足底中、小面积缺损的一种简单、可靠的方法。

Objective To study the anatomic basis and its clinical effects of the adjacent perforator fasciocutaneous flap in planta. Methods From October, 2010 to December, 2017, the work was on two fronts：①The blood supply of the flap was studied by the dissection of 5 adult lower limbs which were perfused with red emulsion. Under the magnifying glass, the source of blood supply to the pedicle perforator fasciocutaneuus gap near the foot was observed, and the caliber of perforating vessels was measured by vernier caliper. ② Methods based on the anatomic study, the adjacent perforator fasciocutaneous flap was designed to repair plantar defect. Eleven cases with defects in planta were treated with the flap including 5 malignant melanoma, 5 refractory wound and 1 pigmented nevus. The size of defects ranged from 1.5 cm×2.0 cm to 4.0 cm×5.0 cm with the size of the flaps ranging from 7.0 cm×3.0 cm to 13.0 cm×7.0 cm. Results Anatomical studies showed that the supply vessels of the fasciocutaneous flap near the perforator of the plantar space were plantar medial arteries. The external diameter was greater than or equal to the 0.5 mm perforating number of about 7, the average outer diameter was （0.85±0.19） mm. The medial plantar artery emits multiple branches along the running direction and forms anastomotic branches in the arch of the foot to ensure the blood supply of the flap. Eleven cases of perforator fasciocutaneous flaps survived, including 1 case of distal necrosis of small area and healed after change dressings. The follow-up results during 6-24 months showed that all patients were walking normally, with full texture and no localized dull pain. Conclusion On the basis of the extent of diseases, projected the adjacent perforator fasciocutaneous flap, the wear resistance and abrasive resistance are improved resulted from flaps with similar skin texture of defects. The donor site can be closed directly without skin graft. It is an simple and reliable method to repair medium and small-sized plantar defects.