足底内侧皮瓣的应用解剖及修复足跟组织缺损的临床应用

目的 报道带神经血管蒂足底内侧皮瓣的解剖特点及修复足跟缺损的应用效果.方法 10具成年人体标本(20侧下肢),解剖观测其足底内侧动脉起源、分支、走行和分布以及该皮瓣的支配神经情况.临床应用带神经血管蒂足底内侧皮瓣修复同侧及对侧足跟皮肤缺损8例,供区植皮.结果 足底内侧动脉深支平均长度(8.9±0.2)cm,3～5条皮支.足底内侧神经的分支5～8支.它包含分布足底皮肤直接皮支3～5支和分布足趾皮肤的趾底固有神经2～4支.8例共用8个皮瓣.皮瓣大小为4 cm×3 cm～5 cm×6 cm,6例带蒂转移修复,2例游离移植.8个皮瓣完全成活,所有病例获随访1个月～1年,皮瓣功能、外形良好.结论 足底内侧皮瓣解剖变异少,血供可靠,不牺牲主要血管,转移后能恢复较好的感觉,是修复足跟皮肤缺损的理想皮瓣

Applied anatomy of the medial plantar skin flaps with repairing heel defects and its clinical application

Objective To explore an anatomical basis for the medial plantar skin flaps and its clinical value of repairing heel defects. Methods The origin,branches,course and distribution of the medial plantar artery and the nerve of flaps were studied in 10 adult cadavers(20 legs).8 cases of homonymy and opposite side heel soft tissue defects with medial plantar skin flaps,aged 10-42 years.Free skin transplantation on the donors. Results The length of media plantar artery deep branch was (8.9±0.2)cm,gives off 3-5 cutaneous branches.Medial plantar nerve have 5-8 branches.it inchdes 3～5cutaneous branches distribute plantar skin and 2-4 plantar digital nerves distribute toes skin.The area of flaps was 4.0 cm×3.0 cm-6.0 cm×5.0 cm in the 8 flaps. 6 pedicle skin flaps were transfenrred to repair homonymy side heel soft tissue defects.2 opposite side heel soft tissue defects were repaired by 2 free flaps.All the flaps were survived. All patients were followed up one months to one year,the function and appearance of the flaps were good.Conclusion The flaps have less anatomic variation or sacrificing major vessels but have reliable blood supply and can restore good sensation after operation.They are ideal flaps for repairing heel soft tissue defects.