跖底血管远端交通支为蒂足背皮瓣的临床应用

Dorsal foot skin flap pedicled on the distal communicating artery of plantar vasculature and its clinical application

目的 研究第１ 跖底动脉与跖背动脉及其交通支在足背远端内侧区发出皮支的分布情况及形成皮瓣的切取方法，并探讨其临床应用效果。方法 显微解剖５ 例成人新鲜截肢足标本，灌注美蓝，观察血管分布及测定跖背、跖底动脉及其交通支的管径。临床以该交通支为蒂，设计足背远端逆行岛状或远端为蒂第１ 趾蹼皮瓣，局部转移修复足背远端或足趾皮肤缺损。结果 第１ 跖背动脉与第１ 跖底动脉有较恒定的吻合支穿过远端跖骨横韧带，其中远端交通动脉外径为１－０６ ｍ ｍ（０－５ ～１－４ｍｍ）。临床应用６ 例，术后皮瓣全部成活，随访８ 个月～４ 年２ 个月，功能与外形满意。结论 该皮瓣能修复足背远端皮肤缺损创面。

Objective To introduce a skin flap containing cutaneous branch of distal communicating artery between the first plantar and dorsal metatarsal artery and its incision method and to investigate its effect in clinical application. Methods Microanatomic study was made on 5 fresh amputative feet,the arteries were dissected and infused with methylen blue to observe their vascular distribution and the external diameter of the vessels was measured.These vessels contained the first dosal metatarsal artery (DMTA) and the first plantar metatarsal artery (PMTA) and the distal communicating artery. The dorsal skin flap pedicled on the plantar vasculature using the distal communicating artery or distally based first web flap was designed for repairing the distally dosal foot or toes skin defect. Results There was a constant anastomotic branching between the first DMTA and first PMTA passing distal to the transverse metatarsal ligament.The external diameter of the distal communicating arteries was 1 06 mm(range 0 5～1 4 mm). In 6 clinically applied cases ,the flaps all survived after operation. The patients were followed up for 8 months～4 years 2 months and it was found that there were satisfactory function and shape. Conclusion This flap can resurface defects resulting from the release of distal dorsal foot contractures.