(足母)横动脉蒂足内侧岛状皮瓣修复足母趾皮肤缺损

Reconstruction of great toe skin defect with retrograde.flow medial pedis island flap used transverse artery of great toe

目的探讨以（足母）横动脉蒂足内侧岛状皮瓣逆行转位修复（足母）趾皮肤缺损的方法和效果。方法49侧灌注红色乳胶成人足标本，解剖观测（足母）横动脉、第1跖底动脉分支及足底内侧动脉深支之间的吻合、分布及外径。临床应用以（足母）横动脉为蒂足内侧岛状皮瓣逆行修复趾皮肤缺损8例，皮瓣切取面积2．5cm×3．5cm～3．5×4．5cm。结果（足母）横动脉与（足母）趾胫侧趾底固有动脉及（足母）趾腓侧趾底固有动脉、第1跖底动脉远侧段吻合形成第1跖趾关节下动脉环。临床设计以罡母横动脉为血管蒂修复（足母）趾皮肤缺损8例全部获得成功。随访6—24个月，平均10个月，皮瓣外形良好，无破溃、臃肿，行走正常。结论以（足母）横动脉为血管蒂的足内侧岛状逆行皮瓣是修复（足母）趾皮肤缺损的理想皮瓣供区。

Objective To explore the methods of repairing great toe soft tissue defect with the reverse medial pedis island flap with transverse artery of great toe. Methods This study was made up of two parts ： an anatomical study and clinical application. In the anatomical study, 49 cadaveric feet were injected with red latex and then anostomosis, distribution and external diameters of transverse artery of great toe, the deep branches of the first plantar metatarsal arteries and the deep branches of medial plantar artery were observed. From September 2006 to December 2012, 8 cases of soft-tissue defects with the retrograde-flow medial pedis island flaps were harvested to cover the soft tissue defects of great toe. Soft tissue defect was form 2. 5 cm ×3.5 cm - 3.5 ×4. 5 cm. Results There was an arterial circle under the first metatarsophalangeal joint which consisted 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 metatarsal artery. This arterial circle under the first metatarsophalangeal joint and arterial network on the surface of abductor hallucis was responsible for the blood supply of the flap of medial pedis. The diameter of the pedicle was great, and the length of the pedicle was longer than in previous reported. In terms of clinical application, all patients were followed up with the mean of 10 months（ range fromn 6-24 months）. All flaps survived totally without diabrosis and swelling. The walking and weight-bearing were normal and the blood supply of foot was good. Conclusion Using of arterial circle under the first metatarsophalangeal joint, the medial pedis island flap has a reliable retrograde blood supply. The reverse point of the reverse medial pedis flap moved forward to th interphalangeal joint. This flap should be considered as a preferential way to reconstruct soft-tissue defects of the great toe.