足背外侧动脉链岛状皮瓣的应用解剖

Applied anatomy of the island flap pedicled with lateral pedis dorsal artery chain

目的探讨足背外侧动脉链的组成,为施行足背外侧动脉链岛状皮瓣手术提供解剖依据。方法用48侧成尸足,解剖观测外踝后动脉跟外侧支、外踝前动脉降支、跗外侧动脉与第四跖背动脉的外径、走行、吻合和分布范围。结果外踝后动脉跟外侧支为腓动脉的终末支,外径(1.0±0.3)mm。外踝前动脉降支外径(1.3±0.3)mm,沿外踝前缘向下走行,在外踝尖的水平分为前、后支,后支与跟外侧支吻合,占97.9%,吻合处的外径(0.8±0.3)mm;前支与跗外侧动脉吻合,占91.6%,吻合处外径(0.6±0.2)mm;跗外侧动脉发出分支与弓形动脉或第4跖背动脉吻合,占95.8%,吻合处的外径(0.6±0.2)mm。足背外侧皮神经与足背中间皮神经司足背外侧皮肤的感觉。结论上述4条动脉吻合形成足背外侧动脉链,扩大了足背外侧皮瓣的切取面积,增加了临床应用的灵活性。

Objective To offer anatomy basis for the lateral dorsal ofpedis island flap by discussing the composition of the lateral dorsal artery chain. Methods Anastomosis, distribution and external diameters of calcaneus branch of lateral posteror malleolus artery, descending branch of the lateral anterior malleolus artery, the lateral tarsal artery and the fourth metatarsal dorsal artery were observed on 48 sides of adult cadaveric foot specimens. Results Calcaneus branch of lateral posteror malleolus artery was the terminal branch of the peroneal artery, with the external diameter of （1.0±0.3）mm. The external diameter of descending branch of lateral anterior malleolus artery was （1.3±0.3）mm. The descending branch was along the anterior edge of lateral malleolus which divided into anterior and posterior branch at the level of prominence of the malleolus. The posterior branch anastomosized with calcaneus branch of lateral posteror malleolus artery, with the occurrence rate of 97.9% and the external diameter of （0.8±0.3）mm. The anterior branch and lateral tarsal artery formed the arterial arch, with the occurrence rate of 91.6% and the external diameter of 0.6±0.2 ）mm. The lateral tarsal artery divided into 1 anastomotic branch with arcuate artery or the fourth metatarsal dorsal artery, with the occurrence rate of 95.8% and the external diameter of （0.6±0.2）mm. The sensation innervation of pedis island flap was as follows： the lateral edge of the foot was supplied by nervus cutaneus dorsalis lateralis pedis accompanied by lateral calcaneal artery, the anterolateral edge by skin branch fi＇om nervus cutaneus dorsalis intermedius pedis. Conclusions The artery chain of lateral dorsal on foot consists of lateral calcaneal artery, descending branch of the lateral anterior malleolus artery, lateral tarsal artery and the 4th metatarsal dorsal artery, which expand the dissection boundary of lateral foot flap and increase the flexibility of clinical application.