跟外侧动脉穿支皮瓣的应用解剖

Anatomic basis of the lateral calcaneal artery perforator skin flap

目的探讨跟腱区及跟部皮肤软组织的血供解剖学,为跟外侧动脉穿支皮瓣的临床应用提供解剖学基础。方法 16侧经红色乳胶灌注的成人下肢标本,解剖观察跟外侧动脉＂垂直段＂及其穿支血管的位置、口径、数目及分布规律。结果位于小腿后骨筋膜鞘深部的腓动脉于外踝尖上（6.6±1.1）cm（5.5~9.4 cm）发出腓动脉前穿支和跟外侧动脉,跟外侧动脉下行穿出分隔小腿后骨筋膜鞘浅、深部之小腿后筋膜隔到达外踝后间隙,于腓骨肌腱与跟腱之间移行,继续绕外踝向前下方分布。小腿下段腓动脉、跟外侧动脉穿支数为（3.6±0.7）支,口径为（0.9±0.29）mm,营养跟腱区及跟部皮肤软组织。结论研究结果显示跟腱区及跟部皮肤软组织的血供主要来源于腓动脉、跟外侧动脉,为跟外侧动脉的命名、临床应用以及小腿中下段皮瓣的设计和跟部手术提供解剖学基础。

Objective To report the vascular anatomy of the integument in the Achilles tendon area,with an emphasis on the lateral calcaneal artery perforators emerging superficially along the lateral margin of the Achilles tendon. Methods 16 cadaveric legs were dissected to investigate the perforators arising from the vertical segment of the lateral calcaneal artery（LCA） in terms of number and location relative to the tip of the lateral malleolus, and distribution. Results The peroneal artery（PA） ended into the anterior perforating branch and LCA at the level of（6.6±1.1） cm（range 5.5~9.4 cm） above the tip of the lateral malleolus. LCA pierced the fascia separating the deep posterior and superficial posterior compartment of the lower leg,proceeded between the Achilles tendon and peroneal tendons. It followed a curve around the lateral malleolus.Both PA and LCA, especially the LCA, gave off an average of（3.6±0.7） perforators with an average diameter of（ 0.9 ± 0.29） mm that contributed to nourishment of the integument overlying the Achilles tendon.Conclusions The integument overlying the Achilles tendon derives its blood supply through the perforators of the LCA primarily and that of the PA secondarily. It provides the anatomic basis for appreciating the LCA with regard to its terminology, clinical significance, perforator flap design and hindfoot surgery.