游离趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指的显微外科解剖

Study on applied anatomy of free hallux nail flap of second toe chimeric composite flap for thumb reconstruction

目的为游离趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指术提供解剖学基础。方法10只新鲜成人尸体足标本,经动脉灌注红色乳胶后进行解剖。系统观测趾和第2趾动、静脉分布规律,测量血管长度及直径;模拟游离踇趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指的术式设计。结果第1跖背动脉在第1趾蹼深层发出2分支:踇趾腓侧趾底固有动脉和第2趾胫侧趾底固有动脉。踇趾腓侧趾底动脉血管(分叉至进入皮瓣)长度(1.82±0.12)cm,直径(1.08±0.06)mm;第2趾胫侧趾底动脉血管(分叉至近侧趾间关节)长度(0.90±0.16)cm,直径(0.82±0.13)mm。静脉分深浅两层,第1、2趾背侧浅静脉汇流入足踝内侧的大隐静脉。模拟再造拇指相互环绕的血管蒂无卡压。结论 趾、第2趾动、静脉血管可保障趾甲皮瓣、第2趾骨复合组织瓣血供,模拟再造拇指相互环绕的血管蒂无卡压;适合设计游离趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指。

Objective To provide the anatomical basis for free hallux chimeric 2nd toe nail skin flap for composite tissue flap for thumb reconstruction. Methods 10 fresh cadaveric foot specimens were dissected after perfusion with red latex. Systematic observation of hallux toe and 2nd toe arterial and venous distribution was performed, and the length and diameter were measured; Free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb operation design was simulated. Results 1st dorsal metatarsal artery in the 1th toes web space deep issued 2nd branches： the lateral plantar proper artery of Hallux the medial plantar proper artery of the second toe. The lateral plantar proper artery of Hallux （Bifurcation into the flap） has a length of （1.82 ± 0.12） cm, anda diameter of （1.08 ± 0.06） mm;The medial plantar proper artery of the second toe has a length of （0.90 ± 0.16） cm and diameter of （0.82 ± 0.13） mm. Veins were located in two layers. The 1st and 2nd dorsal superficial veins drain into the saphenous vein at the medial aspect of the foot and ankle. The reconstructed thumb＇s vascular pedicle underwent no compression. Conclusions The arterial and venous vessels of the 1st and 2nd toes can provide the hallux 2nd toe nail skin flap and 2nd toe of composite tissue flap with blood supply. No compression will occur in the reconstructed thumb＇s vascular pedicle. Suitable for design free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb.