胫后动脉皮支链皮瓣的应用解剖

The applied anatomy of posterior tibial artery cutaneous branches-chain flap

目的为胫后动脉皮支链皮瓣的切取提供形态学基础。方法2017年1月至2018年1月,对10例新鲜男尸正常下肢标本股动脉灌注红色乳胶进行显微解剖,观测胫后动脉皮支的数量、直径、蒂长、穿出点的相对距离和血管吻合丛的位置;用聚乙烯醇-氧化铋灌注制作5例血管造影标本,对胫后动脉皮支的吻合情况进行观测。对乳胶灌注显微解剖的10例标本中直径0.2 mm以上的皮支纳入统计分析,计算胫后动脉所有皮支发出点至内踝和跟结节之间的中点的距离百分比。其次,对远、近两段包含皮支的测量指标数据运用t检验进行比较。然后对胫后动脉皮支在胫、腓侧分布情况运用卡方检验进行比较其差异性。P<0.05为差异有统计学意义。结果①10例标本胫后动脉发出皮支共43条,每例平均4.3条,直径为(0.74±0.26)mm。胫后动脉发出的皮支在胫、腓侧分布位置差异无统计学意义(P<0.05)。②以腘窝中点至内踝和跟结节之间的中点连线为标准距离[100%,(35.71±1.22) cm],胫后动脉远段皮支血管丛聚集点在22.4%的位置,即约小腿远端1/5处,皮支数为3.6条;近端皮支血管丛聚集点在70.39%位置,即约小腿近端1/3,皮支数为0.7条;远、近两端皮支的直径和蒂长差异无统计学意义(分别为P=0.28,P=0.14)。③远端皮支血管丛中,在距离内踝尖端(6.37±1.22) cm处,有粗大(≥1.0 mm)皮支从胫后动脉发出,发出处平均直径(1.11±0.09) mm,平均蒂长(6.53±1.51) mm。④胫后动脉发出的皮支相互间吻合形成血管丛。结论胫后动脉皮支出现恒定,有一定的蒂长和直径;存在着相对密集的2个皮支血管丛,以其为旋转点,近端和远端都可设计成皮支链血管皮瓣。

Objective To provide anatomy information for harvesting the posterior tibial artery cutaneous branches-chain flaps. Methods The research was performed from January, 2017 to January, 2018. Anatomic observation on 10 legs from fresh human cadaver were performed. The location of cutaneous branches of the posterior tibial artery was observed and its diameter and length was measured. Five legs were prepared to investigate the cutaneous branches of posterior tibial artery. The anastomosis of cutaneous branches of posterior tibial artery was observed by PVA-bismuth oxide perfusion for molybdenum target X-ray arteriography in 5 perfused legs. The cutaneous branches with diameter over 0.2 mm in 10 legs of latex perfusion microdissection were included in the statistical analysis. The data were clustered and analyzed to find the location of distant and near cutaneous branches, which was called the gathering point of cutaneous branch vascular plexus. Secondly, the measured data of distal and near segments containing cutaneous branches were compared by t-test. Then the distribution of cutaneous branches of posterior tibial artery on the tibiofibular side was compared by Chi-square test. It was considered to be significant if P value was under 0.05. Results ①There were 4.3 cutaneous branches raised from the posterior tibial artery. There was no significant difference on the tibial and ribula side distribution of the cutaneous branches from the posterior tibial artery(P>0.05).②The distal cutaneous branch clusters was located at about 1/5 of the distal leg and there were 3.6 cutaneous branches raised from the posterior tibial artery. While the proximal clusters was located at 1/3 of the proximal leg and there were 0.7 cutaneous branches raised from the posterior tibial artery. There were no significant differences in the diameters (P=0.28) and pedicle length (P=0.14) between distal and proximal cutaneous branches.③ There were the large cutaneous perforators (≥1.0) mm from the posterior tibial artery at (6.37±1.22) cm proximal to the medial malleolus. The diameter and pedicle length of the distal perforators were (1.11±0.09) mm and (6.53±1.51) mm respectively.④ The vascular chains parallel to the posterior tibial artery were formed via anastomosis of the adjacent cutaneous perforators. Conclusion The cutaneous expenditure of posterior tibial artery is constant, with a certain pedicle length and diameter. There are 2 relatively dense vascular plexus of cutaneous branches. The proximal and distal vascular flaps can be designed with these 2 vascular dense points as rotation points.