拇趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣的应用解剖

Applied anatomy for the flap based on the medial plantar artery of the hallux and included the nutritional arteries of the vein on the medial aspect of the foot

目的：为拇趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣修复足前部软组织缺损提供解剖基础。方法在30侧动脉内灌注红色乳胶的成人足标本上解剖观测：足内侧缘静脉的走行与分布，以及拇趾胫侧底动脉与足内侧缘静脉营养血管间吻合关系。在1侧新鲜足标本上进行模拟手术设计。结果足内侧缘静脉在第1跗跖关节附近，由足背静脉弓内端与拇趾内侧趾背静脉汇合而成，沿足背内缘后行，于内踝附近延续为大隐静脉；踝间线处横径为（3．2±0．5） mm。足内侧缘静脉营养血管为多节段、多源性，其中拇趾胫侧底动脉的位置相对恒定，在第1跖趾关节近端（2．3±0．2） cm处，由拇展肌肌腱与第1跖骨间浅出到达皮肤，并分出众多的细小血管与足内侧缘静脉旁血管链的分支密切吻合。结论拇趾胫侧底动脉蒂足内侧缘静脉营养血管皮瓣可转位修复前足软组织缺损。

Objective To provide anatomic basis for the reconstruction of soft tissue defect of forefoot through investigation of the morphological features of the flap based on arteries of medial part of hallux as the nutritional arteries for the veins in the medial aspect of the foot. Methods Thirty specimens of adult human feet perfused with red latex were used. The following contents were observed under surgical magnifier：the courses, distribution of the vein of the medial border of foot; the anastomoses among the perforator of the arteries of medial partof hallux and nutritional blood arteries of veins in the the medial aspect of foot. Mimic operation was performed on another fresh specimen. Results The vein of the medial border of foot adjacent to the first metatarsal bone was formed by the convergence of the dorsal venous arch and the vein on the medial side of the hallux. It continued as the great saphenous vein adjacent to malleolus medialis. The diameter in the intermalleolar line in was （3. 2 ± 0. 5） mm. The nutritional arteries for the vein in the medial aspect of the vein derived form multiple sources, among which the medial plantar artery of the hallux was relatively consistent in position. It was located （ 2. 3 ± 0. 2 ） cm proximal to the first interphalangeal joint of the foot, emerging superficially between the tendon of the abductor muscle and the first metatarsal bone, giving off minute branches to anastomose with nutritional arteries of the vein from other sources. Conclusions The flap based on the medial plantar artery of the hallux and included the nutritional arteries of the vein on the medial aspect of the foot can be harvested to repair the defect of soft tissue on forefoot.