第2跖趾关节、肌腱及皮瓣复合移植的显微外科解剖

Microsurgical anatomy of complex tissue transplantation with the second metatarsophalangeal joint,tendon and skin flap

目的：为第２跖趾关节、肌腱及皮瓣复合组织移植修复掌指关节、肌腱及皮肤缺损提供应用解剖学基础。方法：在２０侧灌注红色乳胶的新鲜足标本上，对第２跖趾关节、肌腱及邻近皮肤的血供进行了观测；２侧标本摹拟术式设计。结果：第２跖趾关节、肌腱及皮肤由第１、２跖背及跖底动脉供给，其分支间在关节周围和深浅筋膜间形成丰富吻合。其中第１跖背动脉沿途发４～９支、外径０．１～０．３ｍｍ（混合支０．５～０．８ｍｍ）的分支，至关节面以近０．８～１．５ｃｍ与以远０．３～０．８ｃｍ之间的跖趾关节及背侧肌腱和皮肤。结论：以足背动脉→第１跖背动脉为蒂，第２跖趾关节、肌腱及皮瓣复合组织移植，其皮瓣可依据受区需要，设计四种形式。

bjective:To study the applied anatomy of the second metatarsophalangeal joint,tendon and skin flap for reconstructing the defect in the metatarsophalangeal joint region.Methods:Boold supply to the second metatarsophalangeal joint and the surrounding tendon and skin was observed in 20 adult fresh cadaveric feet infiltrated with red emulsion. Simulated operation was performed in 2 specimens.Results:The blood supply to the second metatarsophalangeal joint,tendon and skin comes from the first and the second dorsal and plantar metatarsal arteries which anastomose in the area surrounding the joint and between the deep and superficial fascia.Conclusions:Four types of skin flap were designed in the transplantation of the second metatarsophalangeal joint with the dorsal pedal artery and the first dorsal metatarsal artery.