Alagoz Murat Sahin, Orbay Hakan, Uysal Ahmet Cagri, Comert Ayhan, Tuccar Eray
Department of Plastic and Reconstructive Surgery, Kocaeli University Faculty of Medicine, Kocaeli, Turkey.
J Plast Reconstr Aesthet Surg. 2009 Sep;62(9):1227-32. doi: 10.1016/j.bjps.2007.12.083. Epub 2008 Jun 20.
Utilization of the metatarsal bones and interosseous muscles in foot reconstruction should be based on the vascular anatomy of the metatarsal bones and interosseous muscles. We studied the vascular anatomy of the metatarsal bones and the interosseous muscles to design a split metacarpal musculoosseous flap and dorsal interosseous muscle flap. Twenty-two feet from eleven cadavers that had been embalmed in formalin were studied. Dissection was done using a dissection microscope (x3.5), delineating meticulously the arcuate artery, dorsal metatarsal arteries and the small branches arising from the metatarsal arteries. The dorsal metatarsal arteries do not course at the midline of the interosseous muscles. The first dorsal metatarsal artery proceeds close to the first metatarsal bone in the first metatarsal space. While proceeding to the distal, it shoots out a branch that individually feeds the lateral head of the first dorsal metatarsal muscle and medial face of the second metatarsus, thereby feeding muscle and bone. Except for this branch, the first dorsal metatarsal gives off segmental and periosteal branches that individually feed the medial heads of the first dorsal metatarsal muscle and first metatarsal bone. The second, third and fourth metatarsal arteries proceed close to the third, fourth and fifth metatarsal bones in the metatarsal spaces. In these courses, the arteries give out segmental branches to both faces of the interosseous muscles and periosteal branches to the medial face of metatarsal bones. For defects or disease of the ankle bones, the metatarsal bones can be split at the medial border distally, and a split metatarsal musculoosseous flap, based proximally on the dorsal metatarsal artery, can be done. Distal intermetatarsal anastomoses between the dorsal and plantar vascular networks enables a split metatarsal musculoosseous flap based distally, including the dorsal metatarsal artery for bony defects of the proximal phalanx.
在足部重建中，跖骨和骨间肌的应用应基于跖骨和骨间肌的血管解剖结构。我们研究了跖骨和骨间肌的血管解剖结构，以设计一种劈开的掌骨肌骨瓣和背侧骨间肌瓣。对11具用福尔马林防腐的尸体的22只脚进行了研究。使用解剖显微镜（3.5倍）进行解剖，仔细描绘弓形动脉、跖背动脉以及从跖动脉发出的小分支。跖背动脉并不走行于骨间肌的中线。第一跖背动脉在第一跖骨间隙靠近第一跖骨走行。在向远端走行时，它发出一个分支，单独供应第一跖背肌的外侧头和第二跖骨的内侧面，从而为肌肉和骨骼供血。除了这个分支外，第一跖背动脉还发出节段性和骨膜分支，分别供应第一跖背肌的内侧头和第一跖骨。第二、第三和第四跖动脉在跖骨间隙靠近第三、第四和第五跖骨走行。在这些走行过程中，动脉向骨间肌的两面发出节段性分支，并向跖骨的内侧面发出骨膜分支。对于踝关节骨的缺损或疾病，可在远端内侧缘劈开跖骨，并制作一个以近端为蒂、基于跖背动脉的劈开跖骨肌骨瓣。跖背和跖底血管网络之间的远端跖间吻合使得能够制作一个以远端为蒂的劈开跖骨肌骨瓣，包括用于近端指骨骨缺损的跖背动脉。
