改形趾甲皮瓣与第2足趾联合移植再造拇指术的解剖学基础

Anatomy of thumb reconstruction by transferring modified great toe skin-nail flap and second toe

目的为改形趾甲皮瓣与第2足趾联合移植再造拇指手术提供解剖学基础。方法对10例20侧红色乳胶灌注的成人足标本(其中新鲜足标本5例10侧)进行显微解剖,观测营养趾甲皮瓣、第2足趾骨皮瓣血供。结果趾甲皮瓣的血供为多源性,主要为趾腓侧趾底动脉和趾趾背动脉,二者外径分别为(1.5±0.3)mm、(0.9±0.2)mm;趾甲皮瓣静脉为大隐静脉-第一跖背静脉-趾腓侧趾背静脉;神经为趾腓侧固有神经和腓深神经。剔除第2足趾甲皮瓣的第2足趾骨皮瓣血供为第2足趾胫侧趾底、趾背动脉,外径分别为(0.7±0.1)mm、(0.3±0.1)mm;静脉为大隐静脉-第一跖背静脉-第2足趾胫侧趾背静脉;神经为第2足趾胫侧趾底固有神经。结论趾腓侧趾底动脉、趾趾背动脉及第2足趾胫侧趾底、趾背动脉起始、走行恒定,外径较粗,有较多皮肤穿支和恒定血供范围,可为改形趾甲皮瓣与第2足趾联合移植再造拇指手术提供理想的血供。

Objective To offer anatomic basis for thumb reconstruction by transferring modified great toe nail-skin flap and second toe. Methods 20 adult cadaveric feet perfused with emulsion were microdissected and observed blood supply of great toe skin-nail flap and second toe compound flap.Results There were different blood origin for great toe skin-nail flap,mainly from plantar digital artery on fibular side of 1st toe and hallucis dorsal digital artery,with the diameters of （1.5±0.3）mm and （0.9±0.2）mm respectively. The vein drained into the great saphenous vein from the 1st dorsal metararsal vein and dorsal digital vein on fibular side of 1st; The nerve was the branches of the deep peroneal nerve and fibular marginal plantar digital nerve of 1st. For free composite tissue flap of second toe,its arteries were mainly from dorsal artery on fibular side of 2st toe and dorsal digital artery of 2st,with the diamaters of （0.7±0.1）mm and （0.3±0.1）mm respectively,while,its veins drained into the great saphenous vein from the 1st dorsal metararsal vein and the dorsal digital vein on tibial side of 2st,and its nerve was the branches of the tibial marginal plantar digital nerve of 2st. Conclusions Plantar digital artery on fibular side of 1st toe,hallucis dorsal digital artery,the dorsal artery on fibular side of 2st toe and dorsal digital artery of 2st will provide ideal blood supply for thumb reconstruction adopting modified the second toe and great toe skin-nail flap,for its wide diameter,extensive and plenty of cutaneous branches.