胫后动脉穿支皮瓣设计的应用解剖

目的　为临床设计以胫后动脉肌间隙穿支皮瓣提供解剖学基础。 方法　8例成人新鲜小腿标本，解剖观察胫后动脉肌间隙穿支血管及其分支的分布规律，设计以胫后动脉穿支为血管蒂的显微削薄穿支皮瓣、联体穿支皮瓣、穿支蒂嵌合穿支皮瓣及穿支分叶皮瓣，并模拟皮瓣切取。 结果　胫后动脉平均发出4.8支(3~7支)肌间隙穿支，有3支较恒定、外径较粗的穿支分别位于内踝上(6.7±1.1) cm、(15.8±1.8) cm和(22.6±1.7) cm处；在深筋膜下穿支可发出多支皮支、骨膜支、肌支，骨膜支的穿支主要集中在小腿中段，在同一分支点两皮支起始外径均≥0.5 mm的穿支主要集中在中、上段。 结论　在小腿中、上段的胫后动脉的第1、2穿支较恒定、外径较粗、蒂较长及可发出多种组织分支，适合切取胫后动脉穿支蒂显微削薄穿支皮瓣、联体穿支皮瓣、嵌合穿支皮瓣及穿支分叶皮瓣。

An anatomic study on design of the posterior tibial artery perforator flap

Objective　To provide anatomical basis for posterior tibial artery (PTA)intramuscular perforator flap.　Methods　Eight pieces of adult fresh calf specimens were dissected and the distribution of PTA perforators and branches was analyzed. PTA perforator-based microdissected thin flap, conjoined flap, chimeric perforator flap and polyflap were designed and harvested.　Results The average amount of septocutaneous perforators given off from PTA was 4.8 (3 to7), and the mean outer diameter was (1.10±0.29)mm; three relatively constant perforators were located in (6.7±1.1), (15.8±1.8) and (22.6±1.7) cm, respectively, above the medial malleolus. PTA perforators divided into cutaneous branches,periosteal branch and muscular branches beneath the deep fascia. The perforators from the periosteal branch mainly concentrate on the middle segment of the calf. Perforators which divided into two cutaneous branches with an initial outer diameter great than or equal to 0.5 mm are mainly located in the middle and upper segments of the calf.　Conclusions　The first and second perforators of PTA are relatively constant in the middle and upper segments of the calf, with larger outer diameter and longer pedicle, which can divide into multiple branches supplying various tissues. It is suitable for harvesting PTA perforator-based microdissected thin flap, conjoined flap, chimeric perforator flap and polyflap.