足底内侧岛状皮瓣的解剖学研究对其转移治疗足底恶性肿瘤的意义  

The anatomical study of the island flap from medial plantar and the significance of its transfer treatment for malignant tumor in the plantar

作　　者：史福东[1] 李长江[1] 宋金刚[2] 张志勇[3] 张子明[3] 张宇新[3] 

机构地区：[1]唐山市人民医院骨软组织肿瘤科,河北063001 [2]天津肿瘤医院骨软组织肿瘤科 [3]华北煤炭医学院解剖学教研室

出　　处：《中国骨肿瘤骨病》2009年第3期157-162,共6页Chinse Journal Of Bone Tumor And Bone Disease

基　　金：唐山市科学技术研究与发展指导计划项目(项目编号:08130224a)

摘　　要：目的观察足底内侧岛状皮瓣的血管、神经分布情况,探讨足底内侧岛状皮瓣顺行转移、逆行转移的设计方法,并指导临床治疗足底恶性肿瘤。方法观察16例甲醛固定成人尸体足及2例新鲜足的足底内侧血管、神经的分支、分布情况;观察足底内侧岛状皮瓣的血管、神经分支、分布情况。临床应用皮瓣修复16例足跟区和10例前足区恶性肿瘤切除后软组织缺损。结果足底内侧动脉的走行,分布有明显变异。足底内侧动脉浅支有2～3条皮支入足底内侧岛状皮瓣;深支有3～4个皮穿支入该皮瓣。以近侧端1、2支为主。静脉为与动脉同名的伴行静脉,口径均粗于动脉,均有2条足底内侧神经的皮支分布到该皮瓣。临床应用26例皮瓣成活良好,随访3个月～5年,皮瓣感觉及耐磨功能良好。结论足底内侧岛状皮瓣主要由足底内侧动脉浅支入该皮瓣的皮支营养。顺行转移时可在足底内、外侧动脉分叉点至第I跖骨头后方1 cm的点之间设计皮瓣,必要时需切断结扎足底内侧动脉深支以获得足够长度的蒂。逆行转移时,皮瓣尽可能的设计在近段,蒂部尽可能保留2～3个分支,以保障皮瓣的血供。Objective To observe the distribution of blood vessel and nerve in the island flap from medial plantar, and to investigate the method for anterograde and retrograde design of the island flap, and apply it to the clinical treatment for malignant tumors in the plantar. Methods Sixteen formalin-fixed adult cadavers and 2 fresh feet were observed. The branch and distribution of blood vessel and nerve in the island flap of medial plantar were observed. Island flaps were used to repair the soft tissue defect after the resection of tumor in the heel （n=16）, and in the forefoot region （n=10）. Results Obvious variation of the courser and distribution of medial plantar artery was observed. Two or 3 cutaneous branches of the superficial medial artery of foot distributed into the flap. Three or 4 branches of the deep medial artery distributed into the flap and proximal 1 and 2 branches were major. The vein was associated with the homonymic artery, and its diameter was longer than that of the artery. The cutaneous branches of two medial plantar nerves were in the flap. The flaps survived well in 26 cases after being followed up for 3 to 60 months. Conclusions The flap is nourished mainly by the branches of superficial medial artery. In the anterograde transfer treatment, the flap can be designed in the region which is among the artery and vein bifurcation points and a point lcm behind the first metatarsal head. The deep artery branch should been ligated to harvest enough pedical when it is necessary. In retrograde transfer treatment, the flap should be designed at in the proximal part, and 2 or 3 branches should be kept at the pedical to supply adequate blood.

关 键 词：足底内侧岛状皮瓣 足底内侧动脉 软组织缺损 

分 类 号：R739.96[医药卫生—肿瘤]