足背内侧皮神经营养血管皮瓣修复足远端创面应用解剖

目的：为远端蒂足背内侧皮伸经浅静脉营养血管皮瓣修复足远端皮肤缺损提供解剖学基础。方法：在31侧成人下肢标本f：解削观察足背内侧皮神经分支分布特点，6侧新鲜足标本观测皮神经血供分规律。结果：足背内侧皮神经及其分支恒定的血供来源，近端主要来自胫前动脉末端或足背动脉发m的皮支，外径0．8～1．0mm，内、外侧支远端来自南足底内侧动脉的皮支和第2跖背动脉末端的皮支，皮动脉外径在0.5—0．8mm。皮动脉分支营养神经及神经及浅静脉，在神经和静脉旁分支间形成链式吻合，与筋膜皮肤的血管互相吻合。结论：足背内侧皮神经浅静脉营养血管足背皮瓣可设计两种远端蒂修复足远端创面，(1)以第1跖趾关节内侧近端1．3～1．5cm为旋转轴点。(2)以距第2趾蹼游离缘1．5cm为旋转轴点。

Applied anatomy of dorsalis pedis cutaneous flap pedicled with medial dorsalis pedis cutaneous nerves and vessels repairing the defect of distal end of foot

Objective: To provide anatomic basis for the application of distally based dorsalis pedis cutaneous flap pedicled with medial dorsalis pedis cutaneous nerves and vessels repairing the cutaneous deficiency of distal end of foot. Methods: Features of the branches of the medial dorsal cutaneous nerve of foot were observed on 31 adult cadaver lower extremity specimens, while the blood supplies of cutaneous nerves were analyzed on 6 fresh foot specimens. Results: The permanent proximal blood supply of the medial dorsal cutaneous nerve of foot and its branches originated from the end of anterior tibial artery or the cutaneous branches of arteria dorsalis pedis, which are about 0.8~1.0mm in external diameter. The distal blood supply of the medial and lateral branch originated from cutaneous branch of medial plantar artery and distal cutaneous branch of the 2nd dorsal metatarsal artery, which are about 0.5-0.8mm in external diameter. Cutaneous arteries nourishing nerves and adjacent veins formed a longitudinal or chain-liked anastomosis between the interneural fascicle and veins, and anastomosed with vessels of skin and fascia. Conclusions: Two types of distal base of dorsalis pedis cutaneous flap pedicled with medial dorsalis pedis cutaneous nerves and vessels can be designed to repair distal end of foot, firstly, the point of rotation locates on the proximal end parting from the 1st metatarsophalangeal joint about 1.3~1.5cm, secondly, the point locates on the free edge parting from the 2nd toe web about 1.5cm.