足底弓足背穿支皮瓣的解剖学基础  

Anatomical basis of the flap based on the perforator of plantar arch

作　　者：黄磊[1] 胡德庆[2] 郑和平[1] 林涧[3] 王田俭 钮朋 温福利[1] 

机构地区：[1]蚌埠医学院福总教学医院南京军区福州总医院骨科研究所,福州350025 [2]福建医科大学附属第一医院骨科 [3]上海交通大学医学院附属新华医院显微外科

出　　处：《中华显微外科杂志》2016年第4期363-366,共4页Chinese Journal of Microsurgery

基　　金：福建省自然科学基金项目（2015J01412）;南京军区医学科技创新重大专项（ZX30）;上海市科研计划项目（14411973200）

摘　　要：目的 探讨足底动脉弓足背穿支形态学特征，为足底弓足背穿支皮瓣设计提供解剖学基础。方法2015年11月至2016年3月，选用25侧经动脉内灌注红色乳胶的成人足标本，以第1跖骨底和第5跖骨粗隆为标志．手术放大镜下重点解剖观测：①足底弓足背穿支的起源、走行、分支与分布。②足底弓足背穿支与足背动脉网吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。结果足底弓足背穿支共有3支，穿过第2～4骨问背侧肌两头间至足背分为升、降两支，升支与足背网吻合、降支延续为2～4跖背动脉。足底弓第1～3足背穿支起始外径分别为（1．5±0．3）mm、（1．1±0．4）mm、（0．9±0．3）mm，干长分别为（1．1±0．2）cm、（1．5±0．1）cm、（1．5±0．5）cm。结论以足底弓足背穿支为蒂，可形成足背皮瓣转位或V—Y推进修复足背或前足部软组织缺损。[Abstract] Objective To provide the anatomical basis for the flap based on the perforator of Plantar arch, through investigation of the morphological features of the perforator of the arch of the foot. Methods From November, 2015 to March, 2016, the first metatarsal base and the fifth metatarsal tuberosity were chosen as the observation point on 25 specimens of adult human feet perfused with red latex. The following contents were observed under surgical magnifier： （1）The origin, courses, branches and distribution of the perforator of Plantar arch. （2）Tbe anastomoses among the perforator of Plantar arch and the rete arteriosum dorsale pedis. Mimic operation was per- formed on another fresh specimen peffused with red latex. Results There were 3 perforators in Plantar arch, which passed through the 2nd-4tb metatarsal dorsal muscles to the dorsi pedis and then divided into an ascending branch and a descending branch. The ascending branch anastomosed with the rete arteriosum dorsale pedis, and the descending branch stretched to the 2nd-4tb plantar arteries. The initiative outer diameters of the lst-3rd dorsal perforators of Plantar arch were （1.5±0.3）ram, （1.1 ± 0.4） mm and （0.9 ± 0.3） mm respectively, and the lengths of the stem were （1.1 ± 0.2） cm, （1.5 ± 0.1） cm and （1.5± 0.5） cm respectively. Conclusion The flap can be used for repair of soft-tissue defects of dorsal and front foot through dorsal transposition or a V-Y advancing flap with the perforator of Plantar arch as its vascular pediele.

关 键 词：足底弓 穿支 应用解剖 穿支皮瓣 修复 

分 类 号：R658.3[医药卫生—外科学] R322[医药卫生—临床医学]