第一跖底动脉穿支皮瓣的解剖学基础

Anatomical basis of the flap based on the perforator of the first plantar metatarsal artery

目的 探讨第1跖底动脉穿支的形态学特征,为临床前足软组织缺损修复提供解剖学依据.方法 选用30侧经动脉内灌注红色乳胶的成人足标本,以第1跖趾关节为标志,于手术放大镜下重点解剖观测：①第1跖底动脉穿支的起源、走行、分支与分布;②第1跖底动脉穿支与足内侧血管吻合特点.1侧新鲜标本灌注红色乳胶进行摹拟手术设计.结果 第1跖底动脉穿支于第1跖趾关节近端（2.3 ±0.7） cm处,由足拇展肌肌腱与第1跖骨之间返向后斜行浅出,在足拇展肌上缘与跗内侧动脉、内踝前动脉和足底内侧动脉分支等某一血管体吻合后,再参与动脉链组成,沿途发出细小血管分布于足内侧皮肤.第1跖底动脉穿支起始外径为（1.1±0.2） mm.穿支动脉干长（3.2±0.2）cm.结论 以第1跖底动脉穿支为蒂,可形成轴型皮瓣或跨区域供血皮瓣转位修复前足部软组织缺损.

Objective To investigate the morphological features of the perforator from the first plantar metatarsal artery,so as to provide anatomic basis for the reconstruction of soft-tissue defects of the forefoot.Methods The first metatarsophalangeal joint was chosen as the landmark on 30 human cadaveric feet prefused with red latex.The following contents were observed under surgical magnifier：①The origin,courses,branches,distribution of the perforator of the first plantar metatarsal artery; ②The anastomoses among the perforator of the first plantar metatarsal artery and other arteries on the medial aspect of the foot.Simulated operation was performed on one fresh specimen.Results The perforator of the first plantar metatarsal artery passed through the space between the tendon,the abductor hallucis and the first metatarsal bone,and its entry point into the deep fascia was located （2.3 ± 0.7）cm proximal to the first metatarsophalangeal joint.The perforator anastomosed with either the medial tarsal artery,the medial anterior malleolus artery or the branch of the medial plantar artery on the superior margin of the abductor hallucis,forming a longitudinal arterial chain,through which small branches were given off to the skin of the medial aspect of the foot.The perforator was （1.1 ± 0.2） mm in diameter and （3.2 ± 0.2） cm in length.Conclusion The flap based on the perforator of the first plantar metatarsal artery can be harvested as an axial flap to repair the defects of soft tissue on the forefoot.