内踝区动脉网的显微解剖与隐神经营养血管远端蒂皮瓣的设计

目的：为隐神经营养血管远端蒂皮瓣设计提出解剖学依据。方法：30侧经动脉灌注红色乳胶成年下肢标本，解剖观测内踝区动脉来源、分支、分布及吻合。结果：内踝区动脉有9个来源，构成3条纵向的血管网：(1)内踝前动脉和踝上支的前纵向血管网；(2)骨皮穿支的中纵向血管网；(3)胫后动脉肌间隙支和踝管动脉穿支的后纵向血管网。形成3个层面的血管网：(1)骨膜血管网；(2)深筋膜血管网；(3)皮神经浅静脉血管网。内踝区骨膜、筋膜、大隐静脉、隐神经和皮肤的营养血管同源。结论：内踝区血供来源为多源性，有明显的方向性，吻合十分丰富，可以设计3种包含浅深筋膜、皮神经、浅静脉及其营养血管的小腿内侧远端蒂皮瓣：(1)以胫后动脉肌间隙支为蒂，旋转轴点在内踝最凸出点上3cm；(2)以内踝前动脉筋膜穿支为蒂；(3)以踝管区动脉穿支为蒂，旋转轴点在内踝最凸出点平面。

Microanatomy of artery network of the medial malleolar region and the design of distally based flap of the saphenous nerve nutritional vessels

Objective: To provide anatomic basis for the distally based flap of saphenous nerve nutritional vessels. Methods: The origins, branches, distributions and anastomosis of arteries in the medial malleolar region were observed on 30 adult cadaveric lower limb specimens perfused with red gelatin. Results: 9 origins of arteries in medial malleolar region formed 3 longitudinal vascular plexuses: the anterior longitudinal vascular plexus from medial anterior malleolar artery and perforating branches of superior malleolus, the medius longitudinal vascular plexus from perforating branches between bone and skin, and the posterior longitudinal vascular plexus from intramuscular branches of posterior tibial artery and the perforating artery of the ankle salpinh. 3 layer facial vascular plexuses were formed by those arteries in medial malleolar region: the vascular plexus of periosteum, the vascular plexus of deep fascia, and the vascular plexus of cutaneous nerve-superficial vein. The above nutritional vessels were homologous. Conclusions: There are plentiful blood supplies and rich anastomosis in the medial malleolar region, which are able to be designed into 3 types of flap comprising superficial fascia and deep fascia, nerve, vein and its nutritional vessel on the medial view of the leg: the distally based flap pedicled with intermuscular spave perforating branches of posterior tibial artery, its rotating point is 3cm above the level of medial malleolus. the distally based flap pedicled with the perforating branch of medial anterior malleolus artery and the distally based flap pedicled with perforating artery of the ankle caral area on the medial view of the leg, its rotation point places at the same level of cusp plane in the medial malleolus.