内踝前动脉穿支为蒂隐神经-大隐静脉营养血管远端蒂皮瓣的应用解剖

目的为内踝前动脉穿支隐神经-大隐静脉营养血管皮瓣设计提供解剖学依据.方法30侧经动脉内灌注红色乳胶成人下肢标本,解剖观察踝前内侧区的动脉来源、分支分布及其邻近动脉吻合.结果踝前内侧区动脉,前侧来自内踝前动脉和胫前动脉踝上支穿支,外径平均0.6～0.8mm;后侧来自胫后动脉肌间隙支和骨皮穿支,其中胫后动脉的肌间隙支2～3支,平均外径(0.9±1.2)(0.5～2.5)mm,骨皮穿支1～2支,外径(1.3±0.3)(0.7～2.0)mm.动脉穿支均发出骨膜支、深筋膜支、皮支、皮神经及浅静脉营养支,构成隐神经大隐静脉营养血管,以及深、浅筋膜血管网.结论踝前内侧区的隐神经、大隐静脉、筋膜及皮肤营养血管同源,呈明显的纵向性分布.设计以内踝前动脉筋膜穿支为蒂的隐神经-大隐静脉营养血管皮瓣,远端蒂的旋转点在内踝尖平面,可用于转位修复前足的软组织缺损.

Applied anatomy of saphenous nerve-great saphenous vein nutritional vessels distally-based flap pedicled with perforating branch of medial anterior malleolus artery

Objective To provide anatomic basis for the saphenous nerve-great saphenous vein nutritional vessels flap pediceled with the perforating brandies of medial anterior maileolus artery. Methods The origins,branches,distribution and anastomosis of artery in the medial area of ankle anterior were observed on 30 adult cadaveric low limb specimens was perfused with red gelatin to dissect in the artery. Results The artery of medial area of ankle anterior, orginating from medial anterior malleolar artery and superior branches maileolus of inleral maileolus of anterior tibial artery,the diameters were 0. 6-0. 8mm. In the posterior side, intermuscular septum perforating branches of posterior tibial artery had 2-3 branches and the diameters were 0.9 ~ 1.2mm, perforating branches of bone cutaneous had 1 ~ 2 branches and the diameters were 1.3mm. Above-mentioned perforating branches incluseted fascia branches,utaneous branches, nerve and vein nutrient branches,those nutrient vessels form longitudinal vessel chain of saphenous nerve shaft. vessel chain of vein side and vessel network ol deep superfacial fascia. Conclusion The results suggested that the nutrient vessels of skin,fascia, periorst, great saphenous vein and saphenous nerve were homology. There were sources of supply blood on the medial area of ankle anterior. The saphenous nerve-great saphenous vein nutrient vessels flap pedicled with the perforating branches of medial anterior maileolus artery,its rotating point of flap is eusp of the same level of the medial maileolus, which can be applied repairing forefoot soft tissues defect.