(足母)展肌上缘动脉弓为蒂逆行岛状皮瓣修复前足底皮肤缺损的应用解剖

Applied anatomy of the reverse pedicled island skin flap with arterial arch at the superior border of the abductor hallucis muscle for repairing fore foot skin defect

目的探讨(足母)展肌上缘动脉弓逆行岛状皮瓣的血供来源,为其修复前足底皮肤缺损的临床应用提供解剖学基础。方法新鲜和固定下肢标本各12例,解剖观测(足母)展肌上缘动脉弓形成及伴行神经、静脉的管径、走形、分布情况,据此设计以(足母)展肌动脉弓为蒂逆行足底内侧岛状皮瓣修复前足底皮肤缺损并重建远端血运术式。结果内踝前动脉、跗内侧动脉及其发出分支的前后支与(?)趾底内侧动脉浅支、足底内侧动脉浅支吻合形成的(足母)展肌上缘动脉弓,成为跗内侧、足内侧与足底内侧动脉网的轴心线。内踝前动脉外径(1.02±0.03)mm,伴随静脉外径(1.01±0.03)mm,多为1条,占91.67%,偶见两条,占8.33%;跗内侧动脉外径(0.73±0.04)mm,伴随静脉外径(0.81±0.04)mm,多为1条,占91.67%,偶见两条,占8.33%;足底内侧动脉浅支外径(0.56±0.02)mm,伴随静脉外径(0.57±0.01)mm,多为1条,占91.67%,偶见两条,占8.33%;(足母)展肌上缘动脉弓远端外径(0.53±0.14)mm,伴随静脉外径(0.61±0.02)mm,多为1条,占91.67%,偶见两条,占8.33%。结论 (足母)展肌上缘动脉弓逆行岛状皮瓣可设计三种术式修复前足底皮肤缺损,以内踝前动脉与跗内侧动脉、以足底内侧动脉浅支、以三条动脉共同为主要血供动脉;可设计以第一跖骨颈、第一跖趾关节以远为转移点的两种皮瓣,使该皮瓣血管蒂长、可切取面积大,增加了临床应用的灵活性。

Objective To explore the blood supply of the reverse arterial arch at the superior border of the hallucal abductor island flap and provide an anatomical basis for repairing fore foot skin defect using this flap. Methods The constitution, course, distribution, and external diameter of the arterial arch at the superior border of the hallucal abductor, and the concomitant veins and nerves were observed on 12 sides of formaldehyde-fixed and 12 fresh adult foot specimens perfnsed with red latex. The surgical approach using the arterial arch at the superior border of the hallucal abductor for repairing fore foot skin defect were designed. Results The arterial arch at the superior border of the hallucal abductor, constituted by the branch of the medial tarsal artery or the branch of the anterior medial malleolus artery anastomosed with the superficial branch of the medial basal hallucal artery or the branch of the superficial branch of the medial plantar artery or the all the four branches, functioned as the axis of the medial tarsal, the medialis pedis and the medial plantar. The external diameters of the anterior medial malleolus artery the medial tarsal artery,the branch of the superficial branch of the medial plantar arter~ and the distal arterial arch at the superior border of the hallucal abductor were 1.02±0.03 mm, 0.73±0.04 mm, 0.56±0.02 mm, and 0.53±0.14 mm, respectively. Most of the arteries （91.67%） had one concomitant vein with the external diameters of 1.01~0.03mm, 0.81 ± 0.04 mm, 0.57 ± 0.01 mm, and 0.61 ± 0.02, respectively, and only a small fraction of them （8.33%） had two concomitant veins. Conclusions The fore foot skin defect can be repaired using this flap supplied by the branch of the anterior medial maileolus artery and the medial tarsal artery, the superficial branch of the medial plantar artery, or all the three. The pivot point formed by the neck of the first metatarsal or metatarsophalangeai joint allows for long vessel pedicles and larger flap areas to increase the flexibility of surgery.