Wei Zai-Rong, Wang Da-Li, Wang Yu-Ming, Sun Guang-Feng, Tang Xiu-Jun, Wang Bo
Department of Hand Reconstructive Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China.
Zhonghua Yi Xue Za Zhi. 2009 Jun 9;89(22):1553-7.
To explore an anatomical basis and incising scope for the medial plantar artery combined flaps and its feasibility of repairing heel and adjacent vast soft tissue defects.
The origin, branches, course and distribution of the medial plantar artery were studied in 20 legs of adult cadavers. The largest area of healthy adult's medial plantar and medialis pedis scope that could be incised for the combined flap was measured. Ten cases of heel and adjacent vast soft tissue defects were repaired by the combined medial plantar and medialis pedis flaps. Age range 28-60 years old. The areas of flaps were 9 cm x 7 cm - 10 cm x 8 cm. Defects of tendo calcaneus were repaired by the tendon of abductor muscle and plantar fascia in 3 cases with skin grafts on the donor sites.
The medial plantar artery gave off deep branch (diameter: 1.5 mm +/- 0.3 mm) and superficial branch (diameter: 1.0 mm +/- 0.2 mm). The length of media plantar artery deep branch was (8.9 +/- 0.2) cm and gave off 3-5 cutaneous branches. The largest area of combined flap was about 10.4 cm x 9.2 cm - 9.1 cm x 8.2 cm. Ten flaps survived completely. Eight flaps were followed up for 1 month to 1.5 years. The color, texture and appearance of flaps were excellent. The flaps of two-point discrimination were not different with opposite medial region. The affected limb exercised freely and had no ulceration on the flap.
The combined flap has a reliable blood supply and it can recover good sensation after operation. It is one of ideal flaps to repair heel and adjacent vast soft tissue defects. Its disadvantage is a complicated operation.
探讨足底内侧动脉联合皮瓣的解剖学基础、切取范围及其修复足跟及邻近大面积软组织缺损的可行性。
在20侧成人尸体下肢研究足底内侧动脉的起源、分支、走行及分布。测量健康成年人可用于联合皮瓣切取的足底内侧及足内侧最大范围。采用足底内侧与足内侧联合皮瓣修复10例足跟及邻近大面积软组织缺损患者。年龄范围28 - 60岁。皮瓣面积为9 cm×7 cm - 10 cm×8 cm。3例跟腱缺损采用展肌肌腱及跖腱膜修复，供区植皮。
足底内侧动脉发出深支（直径：1.5 mm±0.3 mm）和浅支（直径：1.0 mm±0.2 mm）。足底内侧动脉深支长度为(8.9±0.2)cm，发出3 - 5支皮支。联合皮瓣最大面积约为10.4 cm×9.2 cm - 9.1 cm×8.2 cm。10个皮瓣全部成活。8个皮瓣随访1个月至1.5年。皮瓣颜色、质地及外观良好。两点辨别觉与对侧足内侧区域无差异。患侧肢体活动自如，皮瓣无溃疡。
联合皮瓣血供可靠，术后感觉恢复良好。是修复足跟及邻近大面积软组织缺损的理想皮瓣之一。其缺点是手术操作复杂。
