足踝部小隐静脉干与属支的解剖观测及其临床意义

目的为更好地处理远端蒂腓肠神经营养血管皮瓣中的小隐静脉以减轻皮瓣静脉血"倒灌"提供解剖依据。方法对40侧福尔马林液浸泡的成人尸体足踝区的小隐静脉干及其属支进行解剖。以踝关节线(经外踝尖的水平线)为基准观测小隐静脉的起始类型,以及足踝部外侧引流静脉汇入小隐静脉干的最高点至踝关节线的垂直距离。结果按足踝部小隐静脉各属支起源、行走路径及汇聚情况将小隐静脉的起始类型分为4类:单主支起始型出现率为47.5%(19侧)、双主支起始型27.5%(11侧)、3主支起始型10.0%(4侧)和4主支起始型15.0%(6侧);按足踝部外侧属支汇入小隐静脉干的最高点至踝关节线的垂直距离可分为3类,低位起始型占10.0%(4侧)、中位起始型35.0%(14侧)和高位起始型55.0%(22侧)。结论在足踝部小隐静脉属支汇聚成干的形式在各标本间均不相同,有些差异较大。故对远端蒂腓肠神经营养血管皮瓣,欲提高阻止静脉血"倒灌"的效果,不仅要结扎小隐静脉干,还必须结扎小隐静脉干结扎线以上且可回流至蒂部的小隐静脉的属支。

Ankle part of small saphenous vein and its tributaries: anatomy and clinical significance

Objective　 To provide anatomic basis for more effectively handling small saphenous vein in the distally based sural neurocutaneous flap in order to alleviate the venous blood regurgitation.　Methods　The small saphenous veins and their tributaries were dissected at the malleolar region of 40 lower extremities of adult cadavers. The line was served as ankle reference line, which passed the tip of the external ankle. The origin patterns of small saphenous vein were observed. The vertical distance between the point of the highest branch jointing small saphenous vein trunck and the ankle reference line was measured.　Results　According to the infusion points and the courses of tributeries, small saphenous veins could be divided into four types: the single trunk type 47.5％（19 cases）, the double trunks type 27.5％（11）, the three trunks type 10.0％（4）, and the four trunks type 15.0％（6）. However, there were three types according to the highest jointing point: the low origin type 10.0％（4）, the average origin type 35.0％（14）, and the high origin type 55.0％（22）.　Conclusions　The origin of small saphenous vein is variable, which implicate that, during the procedure of preparing the distally based sural neurocutaneous flap, not only the small saphenous vein trunks must be ligated, but also the tributeries, which maybe entry the base of flap, need to be handled.