Ballmer F T, Hertel R, Noetzli H P, Masquelet A C
Department of Orthopaedic Surgery, University of Berne, Inselspital, Switzerland.
Surg Radiol Anat. 1999;21(5):297-303. doi: 10.1007/BF01631327.
Based on 30 fresh cadaver dissections a detailed anatomic study of the medial malleolar network is presented with particular attention to the anastomoses between the latter and the vascular axis that follows the saphenous nerve. The medial malleolar network is formed by the anterior medial malleolar artery, branches from the medial tarsal arteries, the posterior medial malleolar artery and branches from the medial plantar artery. A distinct anterior medial malleolar artery and posterior medial malleolar artery could be identified in 80 and 20%, respectively, as well as constant additional small branches arising from the anterior tibial or posterior tibial artery. A constant anastomosis was found between the arcade formed by the medial tarsal arteries and the medial plantar a. in 60%, and the medial branch of the medial plantar artery in 40%, respectively. This anastomosis always gave rise to branches to the medial malleolar network. In the perimalleolar area and with regard to the great saphenous v. a larger anterior and a smaller posterior branch of the saphenous nerve was found in 100 and 90%, respectively. In all dissections, for both branches of the saphenous nerve two to four small, but distinct anastomoses between the medial malleolar network and the perineural vascular axis were identified. These constant anastomoses represent a new and reliable vascular base for the distally-based saphenous neurocutaneous island flap. Thus, the pivotal point of the flap can be chosen in the area of the medial malleolus without respecting the most distal septocutaneous anastomosis between the perineural vascular axis and the posterior tibial artery. Additionally, an illustrative clinical case is presented.
基于30例新鲜尸体解剖，对内踝网络进行了详细的解剖学研究，特别关注了内踝网络与伴隐神经走行的血管轴之间的吻合情况。内踝网络由内踝前动脉、跗内侧动脉分支、内踝后动脉和足底内侧动脉分支构成。分别在80%和20%的解剖中可识别出明显的内踝前动脉和内踝后动脉，以及来自胫前动脉或胫后动脉的恒定额外小分支。分别在60%的解剖中发现跗内侧动脉形成的弓与足底内侧动脉之间存在恒定吻合，在40%的解剖中发现与足底内侧动脉的内侧支存在恒定吻合。这种吻合总是发出分支至内踝网络。在踝周区域，关于大隐静脉，分别在100%和90%的解剖中发现有较大的前分支和较小的后分支。在所有解剖中，对于隐神经的两个分支，均在内踝网络与神经周围血管轴之间识别出两到四个小但明显的吻合。这些恒定吻合为远端蒂隐神经皮岛瓣提供了新的可靠血管基础。因此，皮瓣的关键点可在内踝区域选择，而无需考虑神经周围血管轴与胫后动脉之间最远端的间隔皮支吻合。此外，还展示了一个说明性的临床病例。
