■趾腓侧趾背动脉蒂甲床瓣移植的显微外科解剖

The microsurgical anatomy and transplantation of nailbed flap supplied by fibular branch of first dorsal digital artery of the great toe

目的为临床设计切取[足母]趾腓侧趾背动脉蒂甲床瓣提供解剖学基础。方法选用15只(左侧6例,右侧9例,男性11例,女性4例)新鲜足标本进行红色乳胶灌注,解剖观测[足母]趾腓侧趾背动脉的起始、走行及分布规律和特点。结果[足母]趾腓侧趾背动脉均存在,根据其起源分为:Ⅰ型,[足母]趾腓侧趾背动脉由第1跖背动脉内侧发出9例,占60.00%,起始处直径(1.21±0.34)mm;Ⅱ型,[足母]趾腓侧趾背动脉在近节趾骨由母趾腓侧趾底动脉内侧发出3例,占20.00%,起始处直径(1.13±0.26)mm;[足母]趾腓侧趾背动脉由第1跖背动脉与[足母]趾腓侧趾底动脉在近节趾骨共干发出3例,占20.00%;根据分支优势可分3种亚型:Ⅲa型:第1跖背动脉分支粗大型1例,占6.67%,第1跖背动脉起始处直径0.82 mm,[足母]趾腓侧趾底动起始处直径0.53 mm;Ⅲb型:[足母]趾腓侧趾底分支动脉粗大型1例,占6.67%,第1跖背动脉起始处直径0.51 mm,[足母]趾腓侧趾底动脉起始处直径0.71 mm;Ⅲc型:第1跖背动脉分支与[足母]趾腓侧趾底动脉分支等大型(均细型)1例,占6.67%,分支在第1跖背动脉起始处直径0.41mm,分支在[足母]趾腓侧趾底动起始处直径0.43mm。所有类型[足母]趾腓侧趾背动脉均延伸入甲床,并有皮支滋养上甲皮及腓侧甲廓。结论以[足母]趾腓侧趾背动脉蒂甲床瓣可游离移植修复手指甲床缺损,该术式具有血供可靠、不牺牲主干血管,切取安全,并有营养神经伴行等优点。

Objective To provide anatomic basis for the clinical design of the pedicle flap of the fibular branch of first dorsal digital artery.Methods Fifteen fresh foot specimens(The left side was 6 cases,the right side was 9 cases,11 males and 4 females)were used for red latex infusion.The origins,flowing patterns,distribution patterns and characteristics of the fibular branch of first dorsal digital artery of the great toe were analyzed.Results The fibular branch of first dorsal digital artery of the great toe was found.According to the origin,it was divided into 3 types:Type I.The fibular branch of first dorsal digital artery of the great toe was released from the inside of the first dorsal metatarsal artery for 9 cases which was accounting for 60.00%,with the initial diameter(1.21±0.34.)mm;Type II,The fibular branch of first dorsal digital artery in the proximal phalanx was originated from the lateral of the plantar artery on fibular side of great toe for 3 cases,which was accounting for 20.00%,with the initial diameter(1.13±0.26)mm;Type III,The fibular branch of first dorsal digital artery was distributed by the first dorsal metatarsal artery and the plantar artery on fibular side of great toe in the proximal phalanx for 3 cases which was accounting for20.00%.According to the branch thickness,the type III can be divided into three subtypes:Type IIIa,1 case,The branch of the first dorsal metatarsal artery was preponderance,accounting for 6.67%,the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.82 mm,and the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.53 mm.Type IIIb,1 case The branch of the plantar artery on fibular side of great toe was preponderance,accounting for 6.67.%,the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.51 mm,the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.71 mm;Type IIIc,1 case the branch of the first dorsal metatarsal artery and the branch of the plantar artery on fibular side of great toe were isometrically(generally contracted),accounting for 6.67%,the diameter of the branch of the first dorsal metatarsal artery at starting point was 0.41 mm,and the diameter of the branch of the plantar artery on fibular side of great toe at the starting point was 0.43 mm.All types of the fibular branch of first dorsal digital artery extended into the nail bed,and there were skin branches to nourish the upper nail and the temporal side.Conclusions The pedicle flap of the fibular branch of first dorsal digital artery is easy to be transplant and repair the nail bed defect.This procedure has the advantages of reliable blood supply,no sacrifice of main blood vessels,safe cutting,and nutritional nerves.