足内侧岛状皮瓣逆行转位修复足前部皮肤缺损的解剖与临床应用

The anatomy and clinical applications of the reverse medialis pedis island flap to repair of the forefoot skin detects

目的探讨足内侧岛状皮瓣逆行转位修复足前部皮肤缺损的术式。方法48侧成尸足标本经动脉灌注红色乳胶，5侧新鲜足标本动脉造影，观测蹲横动脉、第一跖底动脉、足底内侧动脉深支的外径、分布及其之间的吻合，并对躅趾底内侧动脉浅支进行分型，观察足内侧皮瓣内的动脉吻合和分布范围。临床上应用足内侧逆行岛状皮瓣修复足前部皮肤缺损12例，男11例，女1例；年龄12-54岁，平均32岁。皮肤缺损面积2．5cm×3．5cm～7．5cm×9．5cm。结果躅横动脉与躅趾胫侧趾底固有动脉、躅趾腓侧趾底固有动脉、第一跖底动脉远侧段吻合形成动脉环。躅展肌上缘动脉弓和足底内侧动脉深支内侧支在躅展肌表面形成动脉网。临床上采用足内侧逆行岛状皮瓣修复足前部皮肤缺损12例均获得成功。皮瓣切取面积3cm×4cm～8cm×10cm。全部病例随访1-3年，平均2年，皮瓣全部成活，无破溃、臃肿，足、踝部功能正常，足部血供佳。结论足内侧岛状皮瓣逆行转位修复足前部皮肤缺损，皮瓣旋转点最远可前移至躅趾近节趾中点，皮瓣切取面积大、血供好、手术方式简便、切取后对足部血供影响较小，是修复足前部皮肤缺损的理想皮瓣。

Objective To explore the methods of repairing forefoot skin detects by the reverse medialis pedis island flap. Methods The Anostomosis, distribution and external diameters of transverse artery of great toe between with the branches of the first plantar metatarsal arteries and the deep branch of medial plantar artery were observed on 48 feet of adult cardaveric specimens. Artery angiography was performed in 5 fresh foots. Clinically, 12 cases of forefoot skin detects were repaired with the reverse medialis pedis island flap by 3 new methods. There were 11 males and 1 female. The patients ranged from 12 to 54 years old, with an average age of 32 years. Results Arterial circle under the first metatarsophalangeal joints consists of transverse artery of great toe, tibial proper plantar digital artery of great toe, fibular proper plantar digital artery of great toe and the distal part of first plantar meatarsal artery. The arterial arch at the superior border of hallucal abductor and the medial branch of deep branch of medial plantar artery formed an arterial reten at abductor hallucis. Clinically, we designed 3 new methods to repair 12 cases of forefeet skin detects successfully with the reverse medialis pedis island flap. All patients were followed up, with the mean of 2 years. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot was good. Conclusion The reverse point of the reverse medialis pedis flapis moved forward to the proximal phalanx, resulting in longer vessel pedicles and increasing the flexibility of clinical application. The skin flap thus formed is ideal for repair forefoot skin detects.