拇趾腓侧微型组织瓣的解剖及临床应用  

The fibular hallux miniature tissue flap： anatomical study and clinical application

作　　者：熊秉刚[1] 欧翰杰[1] 陈健[1] 黎润超[1] 徐雪华[1] 黎明华[1] 

机构地区：[1]南方医科大学附属东莞石龙人民医院手足外科,广东东莞523326

出　　处：《中国美容整形外科杂志》2013年第2期95-97,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的研究拇趾腓侧微型组织瓣的动、静脉的解剖规律及其应用于修饰性再造的临床疗效。方法解剖成人尸体足标本6例及废弃新鲜足拇趾7趾。对拇趾动、静脉进行解剖、观察和测量分析。临床应用3类拇趾微型组织瓣游离移植，再造手指末节26例。结果拇趾腓侧趾底固有动脉的解剖位置恒定，起始部外径平均1．4mm；在趾蹼水平，拇趾腹腓侧浅静脉外径平均1．0mm，拇趾背腓侧浅静脉外径平均1．1mm，且较恒定；与拇指、示指受区需吻合的动静脉管径相近。26例患者中，23例皮瓣完全成活，3例皮瓣边缘部分坏死。其中，20例获得随访1～12个月，再造指体外观饱满，有指甲及指纹，两点分辨觉在6．0～8．0mm，手指功能恢复良好。结论拇趾腓侧微型组织瓣的主要供血源为趾底腓侧固有动脉，其解剖位置恒定，有两套相对恒定的静脉回流系统，拇趾趾背任何平面都有可供吻合的静脉，对皮瓣的成活提供了解剖学基础。拇趾腓侧微型组织瓣修复后的手指外形接近正常，有良好的感觉功能，可恢复精细功能，是手指I度缺损修饰性再造的最佳方法之一。Objective To study the anatomical feature of artery and vein of fibular hallux miniature tissue flap and its application the finger reconstruction. Methods Anatomical study was performed on 6 cadaver feet and 7 fresh deprecated great toe to observe and measure the anatomical relationship of the arteries and veins of great toe. Finger tip defects were reconstructed by 3 kinds of great toe fibular miniature tissue flap in 26 patients. Results The proper plantar hallux artery at the fibular side has a constant anatomical location, with an external diameter of 1.4 mm averagely at the origin. At the web-toed level, the external diameter of the plantar hallux superficial vein at the fibular side is 1.0 mm averagely, and the external diameter of the dorsal hallux su- perficial vein at the fibular side is 1.1 mm averagely. The arteries and veins of the great toe are all anatomically constant, and their external diameters are suitable for vascular anastomosis with the recipient index finger. In all 26 clinical patients, flaps survived completely in 23 cases, and partial flap edges necrosis happened in 3 cases. After postoperative follow-up in 20 cases, the reconstructed finger healed well in both function and appearance with a measurable two-points discrimination of 6.0 to 8.0 mm. Conclusion The blood supply of the fibular hallux minature flap comes from the proper plantar hallux artery, with two constant venous drainage system. The fibular hallux miniature flap is anatomically suitable for the reconstruction of index finger defect, and it is one of the most optimal way for the repair of Level I damage of the finger.

关 键 词：微型组织瓣 拇趾 拇甲瓣 手指再造 

分 类 号：R622[医药卫生—整形外科]