【作者】 魏在荣； 王达利； 王玉明； 孙广峰； 唐修俊； 王波；

【Author】 WEI Zai-rong,WANG Da-li,WANG Yu-ming,,SUN Guangfeng,TANG Xiu-jun,WANG Bo.Department of Plastics,Affiliated Hospital of Zunyi Medical College,Zunyi 563003,China

【机构】 遵义医学院附属医院整形科；

【摘要】 目的探讨足底内侧动脉联合皮瓣的解剖特点及用于足跟部较大皮肤软组织缺损修复的可行性。方法取20条经动脉灌注红色乳胶的成人下肢标本,解剖观察其足底内侧动脉起源、分支、走行和分布。据此设计足底内侧动脉联合皮瓣,对10例足跟部组织缺损9cm×7cm～15cm×14cm的患者进行带蒂皮瓣转移修复。患者中男7例,女3例;年龄28～60岁;交通伤9例,足跟部黑色素瘤1例。对其中3例跟腱缺损者同时携带拇趾展肌肌腱和跖腱膜修复跟腱缺损,供区游离植皮。结果足底内侧动脉在距起点1.0～2.0cm处分为浅、深2支,浅支直径(1.0±0.2)mm,分出2～3条拇趾展肌肌支和3～5条皮支;深支直径(1.5±0.3)mm,在距足底内侧动脉起点2.5～5.0cm处分为外侧深支和内侧深支,前者分出3～5条皮支,后者分出2～3条拇趾展肌肌支和1～2条皮支,长度为(8.9±0.2)cm;足内侧和跖弓区切取联合皮瓣的最大面积男性可达10.4cm×9.2cm,女性可达9.1cm×8.2cm。10例患者足跟部修复手术中切取的联合皮瓣大小为9.0cm×7.0cm～10.0cm×8.0cm,术后10块皮瓣全部存活。8例获1～18个月随访,皮瓣色泽、质地与外形良好,皮瓣植皮处的两点辨别觉与对侧足内侧区无明显差异,患肢活动自如。结论足底内侧动脉联合皮瓣是修复足跟及其周围较大皮肤软组织缺损的理想皮瓣,操作较复杂是其缺点。更多还原

【Abstract】 Objective To explore an anatomical basis and incising scope for the medial plantarartery combined flaps and its feasibility of repairing beel and adjacent vast soft tissue defects.Methods The origin、branches、course and distribution of tlle medial plantar artery were studied in 20 legs of aduhcadavers.The largest area of healthy adult’S medial plantar and mcdialis pedis scope that could be incised for tlle combined flap wag measured.Ten cases of heel and adjacent vast soft tissue defects were repaired by the combined medial plantar and medialis pedis flaps.Age range 28～60 years old The areas of flaps were 9cm×7cm~10cm×8cnl.Defects of tendon calcaneus were repaired by the tendon of abductor muscle and plantar fascia in 3 cases with skin grafts on the donor sites.Results The medial plantar artery give off deep branch(diameter:1.5 mm±0.3 mm)and superficial branch(diameter:1.0mm±0.2 mm).The length of media plantar artery deep branch was(8.9±0.2)cm and gave off 3～5 cutaneous branches.The largest area of combined flap was about 10.4 cm×9.2cm~9.lcm×8.2cm.Ten flaps survired completely.Eight flaps were followed up for 1 month to 1.5 years The color,texture and appearance of flaps were excellent The flaps of two-point discrimination were not different with opposite medial region.The affected limb exercised freely and had no ulceration on the flap.Conclusions The combined flap has a reliable blood supply and it can recover good sensation after operation.It is one of ideal flaps to repair heel and adjacent vast soft tissue defects.Its disadvantage is a complicated operation.更多还原