胫后动脉内踝上皮支皮瓣的供血特点及意义

Blood supply characteristics of medial supramalleolar cutaneous branch flap of posterior tibial artery and significance

目的:通过对胫后动脉内踝上皮支血管铸型标本的观测,探讨胫后动脉内踝上皮支皮瓣移植修复腿足部皮肤软组织缺损的手术设计,阐明胫后动脉内踝上皮支的血供分区及特点,为其临床应用提供解剖学依据。方法:对20侧新鲜成人小腿标本利用血管铸型后行分层碱腐蚀,用游标卡尺和坐标纸法获取各项数据,对胫后动脉内踝上穿支的浅出点、分支、分布、吻合及供血区的形状和面积进行分析。结果:胫后动脉内踝上皮支的浅出点在髁踝连线上投影距离90%集中于8～12cm,平均血管直径为(0.96±0.24)mm;解剖供血区近似椭圆形,面积为(72±8)cm2,占小腿面积的14.22%;以胫后动脉内踝上皮支的浅出点为坐标原点,浅出点至内踝后缘与跟腱中点的连线为坐标系的纵轴,经原点向纵轴作一垂线为坐标系的横轴,将内踝上皮支的的供血区分成4个象限,胫后动脉内踝上皮支各个象限的供血面积:内上象限(15±2)cm2,外上象限(8±3)cm2,内下象限(25±4)cm2,外下象限(24±3)cm2;胫后动脉内踝上皮支的二级分支和三级分支在内上、外下2个象限分布较多,计算其轴向性(Dmax/L)为1.47±0.31;该皮支与周围血管吻合非常丰富,并参与隐神经营养血管链的构成,其动力供血区面积可达小腿内侧面下2/3。结论:胫后动脉内踝上皮支的浅出点相对恒定,其供血区域大,且易于切取和转位,可依据其分支、分布和吻合情况,以胫后动脉内踝上皮支作供血动脉进行双轴点皮瓣和双轴皮瓣的手术设计,修复腿足部皮肤软组织缺损。

Objective To observe the vascular casting specimen of medial supramalleolar cutaneous branch of posterior tibial artery,and investigate the surgical design of medial supramalleolar cutaneous branch flap of posterior tibial artery for the repairing of leg-foot skin and soft tissue defect,and illuminate the blood supply and characteristics of medial supramalleolar cutaneous branch of posterior tibial artery to provide anatomical basis for clinical application.Methods Vascular casting and gradation etching were performed on 20fresh adult cadaver lower legs,series data were obtained with vernier caliper and graph paper;the emerging point,branches, distribution,anastomosis,shape and area of blood supply of medial supramalleolar perforating branch of posterior tibial artery were collected and analyzed.Results In 90%,the emerging point of medial supramalleolarcutaneousbranch of posterior tibial artery were concentrated in 8-12cm of projection distance on condyle-ankle line,the mean diameter of the vessel was（0.96±0.24）mm;anatomical blood supply region was similar to oval,the area was（72±8）cm2,occuping 14.22%of the whole shank.The emerging point of medial supramalleolar cutaneous branch of posterior tibial artery was made as zero point,the line between emerging point and the middle point of posterior border internal malleolus and calcaneal tendon as longitudinal axis,the line through zero and vertical to longitudinal axis as horizontal axis,the blood supply region of medial supramalleolar perforating branch of posterior tibial artery was divided into four quadrants,the blood supply areas of every quadrant were upper inner quadrant （15±2）cm2,upper outer quadrant（8±3）cm2,lower inner quadrant（25±4）cm2,lower outer quadrant （24±3）cm2;the second class branch and third class branch were distributed more in upper inner and lower outer quadrants,the axial direction（Dmax/L）was 1.47±0.31;the cutaneous branch had abundant vascular anastomosis with vessels nearby,and participated in the composition of nutrient vessel chains of saphenus nerve,the effective blood supply region could reach 2/3of inferior medial facies of the shank.Conclusion Medial supramalleolar cutaneous branch of posterior tibial artery has relatively invariable emerging point,large blood supply region,and is easy to cut and transpose.According to its branches,distribution and anastomosis conditions,the surgical design of double axis-point and double axis flaps with medial supramalleolar cutaneous branch of posterior tibial artery can be made as feeding artery to repair leg-foot skin and soft tissue defect.