摘要
目的探讨足背内侧皮神经及其营养血管的解剖特点，为穿支蒂足背内侧皮神经营养血管皮瓣修复前足软组织缺损提供解剖依据。方法2016年12月至2017年4月．在30侧动脉内灌注红色乳胶的成年下肢标本上解剖，另1侧新鲜标本摹拟手术设计。观测指标：①足背内侧皮神经的走行、分支与分布。②足背内侧皮神经的营养血管起源、走行、分支与分布。结果①足背内侧皮神经主要为腓浅神经内侧支的延续，经伸肌下支持带表面，径直前行（2．5-0．4）cm后，分为足背内侧支、第1跖背支和第2跖背支3支，分布于部分足背和趾背皮肤。②足背内侧皮神经营养血管呈多节段、多源性，主要有足背动脉近端穿支、第1跖间隙近端穿支、躅趾胫侧底动脉、第2趾蹼动脉穿支支配。其中第1跖间隙近端穿支与术式关系密切，其穿出深筋膜的位置相对恒定，在第1跖间隙近端1．0～2．0cm范围内穿过深筋膜至皮下。解剖平面较趾蹼动脉穿支、姆趾胫侧底动脉高，并分出众多的细小血管与邻近的穿支血管、足背内侧皮神经其他营养血管密切吻合。③摹拟手术显示第1跖间隙近端穿支蒂皮瓣能满足前足软组织缺损修复。结论第1跖间隙近端穿支穿出点恒定、血供可靠，解剖平面高。以第1跖间隙近端穿支蒂足背内侧皮神经营养血管皮瓣可转位修复前足软组织缺损。
Objective To explore the anatomical characteristics of mediate dorsal pedal cutaneous nerve and its nutritional vessels to provide anatomical basis of the perforator pedicle flap based on the medial dorsal pedal neu- rocutaneous vessels for repairing the forefoot soft-tissue defects. Methods From December, 2016 to April, 2017, the following contents were investigated in 30 adult feet specimens perfused with red latex： （1）The course, branches and distribution of the medial dorsal pedal cutaneous nerve. （2）The origin, course, branches and distribution of the nutrient vessels of the medial dorsal pedal neurocutaneous vessels. Mimic operation was performed on 1 fresh specimen. Results （1）The mediate dorsal pedal cutaneous nerve mainly arose from the medial branch of the superficial peroneal nerve and processed forward for a distance of （2.5±0.4） cm under the surface of the inferior extensor retinaculum, and then divided into the mediate dorsal branch, the 1st and 2nd dorsal metatarsal branch over part of the dorsal pedal and digital skin. （2）The medial dorsal pedal neurocutaneous vessels were multiple segmental and polyphyletic, mainly include dorsalis pedis artery proximal perforator ,the first metatarsal proximal perforator, the tibial proper plantar digital artery of the great toe and the perforater of the second toe web artery, of which the first metatarsal proximal perfo- rator was most associated with operating methods. The first metatarsal proximal perforator perforate through the deep fascia to the subcutaneous area within the range of 1.0-2.0 cm near the proximal first plantar gap, the piercing point of which on deep fascia was constant,and the anatomical plane of the first metatarsal proximal perforator was higher than that of both the perforator of the toe web artery and the tibial proper plantar digital artery of the great toe. The first metatarsal proximal perforator divide into a large number of branches, which closely anastomose with adjacent perforators and other medial dorsal p
作者
洪旭
胡德庆
戚瑞林
林海青
卫旭东
张飞
林涧
郑和平
Hong Xu;Hu Deqing;Qi Ruilin;Lin Haiqing;Wei Xudong;Zhaug Fei;Lin Jian;Zheng Heping(Department of Orthopedics. The First Affiliated Hospital of Fujiau Medical University, Fuzhou 350005, Chin)
出处
《中华显微外科杂志》
CSCD
北大核心
2018年第3期252-255,共4页
Chinese Journal of Microsurgery
基金
军队实验动物专项科研课题（SYDW-2016-007）
福建医科大学启航基金项目（2016QH052）
关键词
第一跖间隙近端穿支
足背内侧皮神经
外科皮瓣
应用解剖
First metatarsal proximal perforator
Medical dorsal pedal cutaneous nerve： Surgical flaps： Applied anatomy
