足背中间皮神经营养血管远端蒂皮瓣的解剖研究与初步应用  

ANATOMICAL STUDIES AND CLINICAL APPLICATIONS OF DISTALLY-BASED INTERMEDIATE DORSAL NEUROCUTANEOUS FLAP ON THE FOOT

作　　者：吴农欣[1,2] 徐永清[1] 李军[1] 覃励明[1] 朱跃良[1] 

机构地区：[1]成都军区昆明总医院骨科全军骨科中心,昆明650032 [2]现在襄樊市中心医院骨科

出　　处：《中国修复重建外科杂志》2007年第4期363-366,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的为足背中间皮神经营养血管皮瓣设计提供解剖学依据,并报道临床应用效果。方法32侧乳胶灌注的成人下肢标本,解剖观测足背中间皮神经及其营养血管的来源、走行、分支分布及其外径。在解剖学研究的基础上,2004年6月-2005年10月设计足背中间皮神经营养血管皮瓣修复足部创面共4例5个皮瓣。结果足背中间皮神经续于腓浅神经,行于踝间线时位于其中点外侧1.3±0.6cm,直径2.05±0.56mm。神经主干于踝间线远端2.8±1.3cm处发出分支,分布于2、3、4跖背及足趾皮肤。足背中间皮神经营养血管平均每侧5.1支。最为恒定的营养血管近端来自胫前动脉、足背动脉的皮支,远端来自跖背动脉,分别位于踝间线近端4.3±0.4cm,直径0.82±0.13mm;第3趾蹼尖近端1.6±0.3cm,直径0.42±0.07mm;第4趾蹼尖近端1.5±0.3cm,直径0.49±0.09mm。临床应用4例5个皮瓣,术后均完全成活,随访4-10个月。外形美观,质地良好。结论足背中间皮神经营养血管远端蒂皮瓣血供可靠,是一种理想的修复足部创面的皮瓣供区。Objective To provide the anatomic basis for the design of the intermediate dorsal neurocutaneous flap on the foot and to report the clinical results. Methods On 32 adult cadaver lower limb specimens perfused with red latex, the origins, diameters, courses, branches, and distributions of the intermediate dorsal cutaneous nerve of the foot and its nutrient vessels were observed. On this anatomic basis, from June 2004 to October 2005, 5 flaps were developed and applied to the repair of the soft tissue defect in the feet of 4 patients. Results The intermediate dorsal cutaneous nerve of the foot was found to arise from the superficial peroneal nerve. Crossing the intermalleolar line, it was located 1.3±0. 6 cm lateral to the midpoint of the line with a diameter of 2.05±0. 56 mm. The nerve stem divided into branches 2.8±1.3 cm distal to the line. They distributed the dorsal skin of the second, third and fourth metatarsal and toe. On average, 5. 1 perforators per specimen were identified. At least 3 nutrient vessels were always found in each. They originated from the cutaneous branches of the anterior tibial artery and the dorsalis pedis artery in the proximal end and the dorsalis metatarsal artery in the distal end. They perforated the deep fascia 4.3±0. 4 cm proximal to the intermalleolar, 1.6±0.3 cm proximal to the tip of the third toe webspace and 1.5±0. 3 cm proximal to the tip of the forth toe webspace, respectively. The external diameters of them were 0. 82±0. 13, 0.42±0. 07 and 0.49±0.09 mm, respectively. The patients were followed up for 4-10 months. All the flaps survived completely. Their appearance and function were satisfactory. Conclusion The distally-based intermediate dorsal neurocutaneous flap on the foot has an abundant blood supply. This kind of flap is especially useful in repair of the soft tissue defect in the foot.

关 键 词：足背皮神经营养血管皮瓣 足部修复 

分 类 号：R658.3[医药卫生—外科学]