足底内侧动脉深支远端穿支皮瓣的血管解剖和临床应用研究  

Anatomy and clinical application of perforator flap from distal deep branch of medial plantar artery

作　　者：刘辉 邓呈亮 陈健达 周晓帆 杨天文 虞华 黄才智 魏在荣 王达利 Liu Hui;Deng Chengliang;Chen Jianda;Zhou Xiaofan;Yang Tianwen;Yu Hua;Huang Caizhi;Wei Zairong;Wang Dali(Department of Burns and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi 563003,China;Department of Orthopaedics and Plastic Surgery,Second People’s Hospital of Guizhou Province,Guiyang 550001,China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,563003 [2]贵州省第二人民医院骨科整复外科,贵阳550001

出　　处：《中华整形外科杂志》2020年第9期1005-1010,共6页Chinese Journal of Plastic Surgery

基　　金：国家自然科学基金(81871570)。

摘　　要：目的探讨足底内侧动脉深支远端穿支皮瓣的血管解剖及逆行修复[足母]趾皮肤软组织缺损的效果。方法对1例男性成人足部标本的动脉灌注红色乳胶后进行血管解剖,观察足底内侧动脉及分支、足背动脉及其分支的分布吻合情况。选取2016年9月至2019年9月于遵义医科大学附属医院就诊的[足母]趾皮肤软组织缺损的患者12例,采用逆行足底内侧动脉深支远端穿支皮瓣进行修复,供区游离皮片移植修复。观察皮瓣成活以及并发症发生情况。结果经解剖研究可见足底内侧动脉深支是足底内侧动脉的直接延续,走行于趾短屈肌与[足母]展肌之间,沿途发出多条穿支,近端穿支穿过[足母]展肌,与足内侧动脉浅支和内踝前动脉、跗内侧动脉吻合,在第1跖趾关节近端发出3条穿支,即关节支、皮穿支和交通支,皮穿支为足底内侧动脉深支远端穿支皮瓣的主要血供来源。临床12例患者共切取皮瓣12块,面积为4.5 cm×3.0 cm^9.0 cm×6.0 cm,3例术后皮瓣出现颜色暗紫、少许水泡,立即给予拆除蒂部缝线,外涂抗生素软膏保持湿润等处理,术后5 d皮瓣颜色逐渐好转。12块皮瓣最终均完全成活。所有患者均获2~12个月电话随访,皮瓣色泽、质地、外形良好,患足可正常行走。结论足底内侧动脉深支远端穿支皮瓣血供可靠,将其逆行修复第1跖趾关节以远[足母]趾中小面积的皮肤缺损,操作简单、创伤小、术后效果较好。Objective To investigate the anatomy and therapeutic effecton skin soft tissue defect at the great toe of perforator flap from distal deep branch of medial plantar artery.Methods The arteries of one adult foot specimens were filled with red latex and vascular anatomy was performed.Branch distribution and anastomosis of medial plantar artery and dorsal foot artery were observed.The clinical data of 12 patients with skin soft tissue defect at the great toe repaired by retrograde perforator flap from distal deepbranch of medial plantar artery from September 2016 to September 2019 in Affiliated Hospital of Zunyi Medical University was selected,and the donor sites were repaired with skin grafts.The flap survival and complications were observed.Results Anatomy result demonstrated that deep branch of the medial plantar artery was direct continuation of the medial plantar artery.It traveled along between short toe flexor muscle and abductor hallucis muscle,and gave out several perforators.The proximal perforators passed through the abductor hallucis muscle,and anastomosed with superficial branch of medial plantar artery,anterior medial malleolus artery,and medial tarsal artery.Three perforators were issued at the proximal end of the first metatarsophalangeal joint,namely articular perforator,cutaneous perforator,and communication branch.The cutaneous perforator was main blood supply source for perforator flap from distal deep branch of medial plantar artery.A total of 12 skin flaps were harvested from 12 patients,with an area from 4.5 cm×3.0 cm to 9.0 cm×6.0 cm.Postsurgery dark purple and a few blisters occurred in three flaps,and the sutures at the pedicle were immediately removed,and the flap was coated with antibiotic ointment to keep it moist,then the flap color gradually improved after postsurgery 5 days.12 skin flaps eventually survived completely.All patients were followed up by telephone for 2-12 months.The flap color,texture and appearance were excellent.The traumatic feet walked normally.Conclusions The perfo

关 键 词：外科皮瓣 穿支皮瓣 解剖学 临床研究 足底内侧动脉 

分 类 号：R658.3[医药卫生—外科学]