外踝部皮动脉皮瓣解剖学的研究及分析

Microsurgical anatomy of cutaneous arteries in the lateral malleolus

目的进一步了解外踝部皮动脉的分布规律,为皮瓣的合理应用提供可靠的解剖学依据。方法24侧成人新鲜下肢,经股动脉行带色乳胶灌注,乳胶凝固成型后在10倍手术显微镜下解剖观察。碳素墨水灌注新鲜下肢,在外踝上、中、下部各取2.0cm×2.0cm的皮肤和皮下组织一块,石蜡包埋后,制成50μm厚的连续组织切片,二甲苯透明后,50倍光学显微镜下观察各层血管网分布。结果腓动脉外踝上皮支出现率为100%,深筋膜穿出点位于外踝平面上(5.38±3.11)cm,穿出点动脉外径(1.14±0.33)mm。参与外踝血管网的主要血管有跗外侧动脉、足跟外侧动脉和足底外侧动脉。在光学显微镜下,皮肤和皮下组织中可见3层微血管网,各区之间微血管网无明显差异。结论该皮瓣具有血管位置恒定且浅表,吻合血管丰富,不损伤主要血管等优点,在修复足外侧远端皮肤缺损中,有很重要的作用。

Objective To dearly define the blood vessel distribution in the lateral malleolns and provide reliable anatomical guidance for application of skin flaps. Methods Twenty - four freshly amputated 2 adult lower limbes were perfused with colored emulsion through the femoral artery, All of them were dissected and evaluated under a 10× operating microscope. One fresh lower limb was perfused with carbon ink. A 20 cm×20 cm portion of skin and subcutaneous tissues was taken from the upper, middle and lower regions of the lateral malleolns. These tissues were cut consecutively into 50μm sections after paraffin embedding. The distribution of blood vessels in all sections was observed under 50× microscopic magnification. Results The frequency of the superior cutaneous branch of the lateral malleolns was 100 %. The distance from the appearance point to the lateral malleolns was（5.38±3.11） cm. The diameter of the artery at the appearance point was（ 1.14±0.33） mm. The supply of the microvasculer net in the lateral malleolus consisted mainly of 3 arteries, including the lateral tarsal artery and lateral arteries on the heel and sole, which could be observed in the skin and sbucutaneons tissue under the microsoope. Conclusion The reverse superior lateral malleolns skin flap with its advantages of permanent and superficial position, abundant anastcomosis with adjacent vessels and undamaged the main artery is an ideal flap repairing soft tissue deformities at the distal end of the lateral foot.