足内侧穿支皮瓣设计的解剖基础

目的    为足内侧穿支皮瓣的临床应用提供解剖基础。  方法　对8侧乳胶灌注的成人下肢标本足内侧区进行显微解剖，观测各穿支血管的位置、数目、外径、蒂长及吻合等情况。  结果　足内侧区皮肤的血供有：足底内侧动脉、内踝前动脉、跗内侧动脉和母趾胫侧动脉。足底内侧动脉浅支穿母展肌在舟骨粗隆附近浅出，外径（1.08±0.20）mm；深支从母展肌和趾短屈肌的间隙内向足底内侧平均发出5.3支穿支，平均外径（0.63±0.25）mm，蒂长（0.93±0.31）cm；内侧深支的内侧支由舟骨粗隆前（1.92±0.61）cm处从母展肌上缘浅出至足内侧。母趾胫侧动脉从第一跖趾关节近侧（2.03±0.56）cm处穿出至足内侧。足底内侧动脉浅支、内侧深支的内侧支与内踝前动脉、跗内侧动脉吻合形成展肌上缘动脉弓，动脉弓的远端与母趾胫侧动脉相吻合。  结论　足内侧穿支皮瓣可设计以不同的穿支为蒂进行带蒂转移，修复前足、踝部及足跟周围软组织缺损，也可设计游离皮瓣修复手指掌侧软组织缺损。

The anatomical basis of design of medial pedis perforator flap

Objective  To provide anatomical foundation for clinical application of themedial pedis perforator flap. 　Methods　The number，length，origin， exteriordiameter and anastomosis of the perforators of the medial plantar artery which were distributed to the area of medial pedis were observed and measured on 8 adult fresh lower limb specimens perfused with red latex.　Results　The blood supply of the medial pedis area included medial plantar artery, medial anterior malleolar artery, medial tarsal arteries and tibia toe lateral artery. 5.3 perforators in average were identified in the medial intermuscular septum between abductor hallucis and flexor digitorum brevis, which were sent out to the non weight bearing area of medial plantar aspect. Among these the first and second perforators were larger and longer in external diameter and length of pedicle. The medial branches of medial plantar deep artery sent out cutaneous branches to the medial pedis area at (1.92±0.61) cm ahead of Scaphoid tuberosity. The tibial artery of hallux went through to the medial pedis area at (2.03±0.56) cm proximal to the fist plantar toe joint and formed anastomotic arch on the abductor muscle.　Conclusions　The medial pedis perforator flap can be designed as pedicle flaps for resurfacing defects around the heel and forefoot, and free perforator flaps can be harvested forresurfacing pulp defects of digits.