足趾微型组织瓣血供的显微解剖研究与临床应用

目的　通过对趾足底动脉和趾底固有动脉的走行规律与不同平面血管外径的显微解剖研究，以及临床应用6类足趾微型组织瓣游离移植修复拇、手指部分缺损，为足趾微型组织瓣移植的血供重建提供指导。 方法　利用12只新鲜尸体足标本，对第1~4趾足底动脉、第1~4趾趾底固有动脉进行显微解剖、观察、测量分析。临床应用6类足趾微型组织瓣游离移植修复拇、手指部分缺损51例。 结果　第1~4趾足底动脉由足底深弓发出,起始外径为 (1.24±0.36)、(1.16±0.32)、(1.10±0.27)、(1.09±0.29) mm。第1趾腓侧趾底固有动脉起始外径为(1.09±0.21) mm；第2~4趾胫侧趾底固有动脉起始外径为 (0.98±0.24)、(0.85±0.18)、(0.82±0.17) mm。临床应用51例足趾微型组织瓣游离移植全部成活，功能恢复均为优，外观优良。 结论　第1~4趾足底动脉解剖位置与走行恒定。第1趾微型组织瓣的主要供血动脉为腓侧趾底固有动脉，第2~4趾微型组织瓣的主要供血动脉为胫侧趾底固有动脉。

The microscopic anatomical and clinical study of little free flap harvested from toes

Objective To provide guides for transplantation of six kinds of little free flap harvested from toes by further exploring the course and diameter of four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe at different plane, and apply these kinds of small-sized free flaps to repair subtotal defect of thumb and fingers. Method Twelve fresh foot specimens were dissected, observed and measured about four plantar metatarsal arteries and plantar digital arteries of the 1st, 2nd, 3rd and 4th toe. The transplantation of six kinds of small-sized free flaps harvested from toes was applied to repair subtotal defect of thumbs and fingers in 51 cases. Result The 1st, 2nd, 3rd and 4th plantar metatarsal artery originated from the deep plantar arterial arc，whose diameter was (1.24±0.36)，(1.16±0.32)，(1.10±0.27) and (1.09±0.29) mm，respectively，at the origin. The diameter of the fibular plantar digital artery of 1st toe was (1.09±0.21) mm at the initial site. The diameter of the tibial planter digital artery of the 2nd, 3rd and 4th toe was (0.98±0.24) mm, (0.85±0.18) mm, (0.82±0.17) mm at the initial site. All transplants survived. The period of following-up was from two to fifteen months postoperatively. All cases were graded as excellent as assessed using Criterion of Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery. Conclusion The four plantar metatarsal arteries were constant in their location and course without remarkable variation. The main blood supply of the small-sized free flap harvested from toes is from plantar digital artery. The main blood supply of the small-sized free flap harvested from 1st toe is from the fibular plantar digital artery, and that of the small free flap harvested from the 2nd, 3rd or 4th toe is from fibular planter digital artery. Transplantation of six kinds of small-sized free flaps harvested from toes is an optimal method for repairing subtotal defect of the thumb and fingers.