Panchbhavi Vinod Kumar, Yang Jinping, Vallurupalli Santaram
University of Texas Medical Branch, Galveston, Texas 77555-0165, USA.
Foot Ankle Int. 2008 Jan;29(1):42-8. doi: 10.3113/FAI.2008.0042.
The flexor digitorum longus (FDL) tendon is harvested for use in the reconstruction of dysfunctional adjacent tendons such as the posterior tibial and the Achilles tendons. The approach to harvest the FDL tendon in the midfoot region is through an incision along the medial border of the foot. This approach involves dissection quite deep in the foot across neurovascular structures in the vicinity placing them at risk. The purpose of this cadaver study was to test the feasibility and safety of a minimally invasive technique, and also to define the relevant topographical surface and deeper surgical anatomy.
In 83 cadaver feet, the FDL tendon was harvested proximally in the hindfoot after it was cut through a small plantar incision in the midfoot. All the tissues superficial to the FDL tendon were then reflected to check for damage to the adjacent neurovascular structures. Measurements were obtained to define the location of the point of division of the FDL tendon in relation to the plantar surface of the foot and the adjacent neurovascular structures.
In all of the 83 feet it was possible to harvest the FDL using this technique. In 11 feet (13.25%), a connecting band to the flexor hallucis longus tendon (FHL) required division. No damage was apparent to the adjacent neurovascular structures. The FDL division was located topographically on the plantar surface of the foot, approximately midway between the back of the heel and the base of the second toe and at this midpoint, about two-thirds of the width medially from the lateral border of the foot.
The FDL tendon can be harvested in the hindfoot after its division through a small plantar incision in the midfoot. Surface anatomy guides placement of the plantar incision over the FDL division.
The plantar approach when compared to the medial approach for harvesting the FDL tendon in the midfoot may be associated with a smaller incision, minimal dissection, lesser risk to adjacent neurovascular structures and lesser morbidity.
趾长屈肌腱（FDL）常被用于修复功能障碍的相邻肌腱，如胫后肌腱和跟腱。在中足区域获取FDL肌腱的方法是沿足内侧缘做切口。这种方法需要在足部较深处进行解剖，穿过附近的神经血管结构，使其处于危险之中。本尸体研究的目的是测试一种微创技术的可行性和安全性，并确定相关的体表和深部手术解剖结构。
在83具尸体足中，通过中足的一个小足底切口切断FDL肌腱后，在足跟近端获取该肌腱。然后将FDL肌腱表面的所有组织翻开，检查相邻神经血管结构是否受损。进行测量以确定FDL肌腱切断点相对于足底表面和相邻神经血管结构的位置。
在所有83只足中，均可用该技术获取FDL肌腱。在11只足（13.25%）中，需要切断与拇长屈肌腱（FHL）的连接带。相邻神经血管结构未见明显损伤。FDL肌腱切断点在足底表面的位置，大约在足跟后部和第二趾基部之间的中点，在该中点处，从足外侧缘向内侧约为足宽度的三分之二。
通过中足的小足底切口切断FDL肌腱后，可在足跟近端获取该肌腱。体表解剖可指导在FDL肌腱切断点上方做足底切口。
与中足内侧入路获取FDL肌腱相比，足底入路可能切口更小、解剖范围更小、对相邻神经血管结构的风险更小且发病率更低。
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