摘要
背景：足内侧皮瓣因其有较好的色泽和质地，还能恢复保护性感觉，在临床应用较广泛，但该皮瓣的支配神经缺乏详细的解剖学资料。目的：在明确局部解剖关系的基础上．采用带隐神经的足内侧皮瓣修复跟腱周围组织缺损，观察修复效果。设计：单一样本研究。单位：合肥医学院附属医院整形科和合肥医学高等专科学校解剖教研室。对象：选择2004-01／2007-06合肥医学院附属医院整形外科收治的跟腱及局部皮肤缺损患者11例进行缺损修复，其中男7例，女4例，年龄15-40岁。方法：实验于2004-01／2007-06在贵州省合肥医学高等专科学校解剖教研室完成。20侧下肢标本来自合肥医学高等专科学校解剖教研室12条肢体以及合肥医学院附属医院整形外科患者截肢的8条肢体（患者同意将截肢用于实验）。20侧灌注红色乳胶的成人下肢标本，重点显微解剖：①足底内侧动脉的起源、走行、分支、外径、长度和分布。②隐神经在内踝下的分支、分布。同期在贵州省合肥医学院附属医院整形科完成采用带隐神经的足内侧皮瓣修复跟腱周围组织缺损11例，皮瓣均采用带蒂转移修复缺损，治疗方案经医院伦理委员会批准。术后采用回院复诊的形式完成随访1个月～2年，观察皮瓣的色泽、质地和与对侧足内侧区两点辨别觉差异。主要观察指标：支配带隐神经的足内侧皮瓣的血管神经情况和该皮瓣转移修复跟腱周围组织缺损后的外观和功能。结果：①解剖学观测结果：足底内侧动脉在距其起始1．0～2．0cm处分为浅、深两支。浅支穿拇趾展肌，在舟骨粗隆附近浅出，外径（1．0±0．2）mm（成人）。足底内侧动脉深支为足底内侧动脉的直接延续，外径（1．5±0．3）mm（成人），距足底内侧动脉起点2．5～5．0cm处分为内侧深支和外侧深支内侧深支在拇趾展肌深面潜行，在舟骨粗隆下方距内、外侧深支分支处再分为内侧支（皮支）和外侧支。②临床应用；本组共用11个皮瓣，皮瓣早期无血管危象发生、未出现皮瓣坏死、完全成活，无患者发生血管危象。7例获随访，其中2例随访1个月，3例随访6个月，1例随访1年，1例随访2年。随访期间观察到移植的皮瓣色泽、质地、外形良好。皮瓣与对侧足内侧区两点辨别觉无差异。结论：足内侧皮瓣由足底内侧动脉浅支供血，是隐神经的绝对支配区。隐神经支配的足内侧皮瓣能够修复跟腱及其周围组织缺损，且具有解剖变异少，切取容易等解剖恒定优势，修复效果较好。
BACKGROUND： Medialis pedis flaps have been widely used in the clinical practice due to their good color and luster, texture as well as the restoration of protective sensation. But little is known about the precise anatomic data of innervation of medialis pedis flaps. OBJECTIVE： Based on identification of local anatomic relationship, this study was designed to repair tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve and observe the repairing effects. DESIGN： A single-sample study. SETTING： Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College ＆ Department of Anatomy, Zunyi Medical and Pharmaceutical College. PARTICIPANTS： Eleven patients. with defects at Achilles tendon and/or local skin, who received treatment in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College between January 2004 and June 2007, were recruited into the present study. These patients, composed of 7 males and 4 females, were aged 15 40 years. METHODS： This experiment was performed at the Department of Anatomy, Zunyi Medicai and Pharmaceutical College between January 2004 and June 2007. Twenty specimens of lower limb were from 12 cadavers obtained in the Department of Anatomy, Zunyi Medical and Pharmaceutical College and from 8 amputated extremities in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College （Informed consents for the application of amputated extremities have been acquired from the patients）. The 20 specimens of adult lower limb were perfused with red emulsion to anatomically study the origin, course, number, size and distribution of the medial plantar artery and the number and distribution of the saphenous nerve in the mediai malleolus. Concurrently, repair of tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve was performed in 11 patients in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College. Pedicle skin flaps were used in the I 1 patients by transplantation. The Hospital＇s Ethics Committee approved the following protocol. After surgery, 1-24-month follow-up observation was performed by further consultation to study the color and luster, and the texture of the flaps, as well as the two-point discrimination difference compared with the opposite medial plantar area. MAIN OUTCOME MEASURES： Vascular nerves, which dominate medialis pedis flaps with saphenous nerve, as well as the appearance and function of these flaps after repairing tissue defects adjacent to Achilles tendon. RESULTS： Anatomic observation results： 1.0 2.0 cm after its origin, the medial plantar artery divided into a superficial and a deep branch. The superficial branch of the medial plantar artery passed through the abductor muscle of great toe and originated around the tuberosity of navicular bone with an outer diameter of （1.0 ± 0.2） mm （adult）. The deep branch was the direct continuation of the medial plantar artery, with an outer diameter of （1.5± 0.3） mm （adult）. 2.5 5.0 cm away from the medial plantar artery, the deep branch divided into a medial deep and a lateral deep branch. The medial deep branch passed through the abductor muscle of great toe deeply and sub-divided into the mediai branch （cutaneous branch） and the lateral branch at the branching point of the medial and laterai deep branches. Clinicai application： Altogether I l flaps were used in the present study. All flaps were successfully transplanted without early vascular risk or flap necrosis. Among 7 patients followed up, 2 were followed up for l month, 3 for 6 months, 1 for 1 year, and 1 for 2 years. Follow up results showed that the transplanted flaps had good color and luster, texture, and appearance. There was no difference in two-point discrimination between the flap and the opposite medial plantar area. CONCLUSION： Medialis pedis flaps is blood-supplied by the superficiai branch of the medial plantar artery that is an absolutely dominated area of the saphenous nerve. Medialis pedis flaps with saphenous nerve can repair Achilles tendon and adjacent tissue defects, possessing the advantages of less anatomic variation, easy resection, and good repair effects.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2008年第40期7971-7974,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
基金
the Grant from Health Department of Guizhou Province,No.2006D-251~~
