Tan Wei, Guli Zhaer Abudurexiti, Huang Wenhua, Jiang Xiaorong
Department of Orthopedic Surgery, Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2012 Nov;32(11):1592-6.
To explore the blood supply of the reverse arterial arch at the superior border of the hallucal abductor island flap and provide an anatomical basis for repairing fore foot skin defect using this flap.
The constitution, course, distribution, and external diameter of the arterial arch at the superior border of the hallucal abductor, and the concomitant veins and nerves were observed on 12 sides of formaldehyde-fixed and 12 fresh adult foot specimens perfused with red latex. The surgical approach using the arterial arch at the superior border of the hallucal abductor for repairing fore foot skin defect were designed.
The arterial arch at the superior border of the hallucal abductor, constituted by the branch of the medial tarsal artery or the branch of the anterior medial malleolus artery anastomosed with the superficial branch of the medial basal hallucal artery or the branch of the superficial branch of the medial plantar artery or the all the four branches, functioned as the axis of the medial tarsal, the medialis pedis and the medial plantar. The external diameters of the anterior medial malleolus artery, the medial tarsal artery, the branch of the superficial branch of the medial plantar artery, and the distal arterial arch at the superior border of the hallucal abductor were 1.02∓0.03 mm, 0.73∓0.04 mm, 0.56∓0.02 mm, and 0.53∓0.14 mm, respectively. Most of the arteries (91.67%) had one concomitant vein with the external diameters of 1.01∓0.03 mm, 0.81∓0.04 mm, 0.57∓0.01 mm, and 0.61∓0.02, respectively, and only a small fraction of them (8.33%) had two concomitant veins.
The fore foot skin defect can be repaired using this flap supplied by the branch of the anterior medial malleolus artery and the medial tarsal artery, the superficial branch of the medial plantar artery, or all the three. The pivot point formed by the neck of the first metatarsal or metatarsophalangeal joint allows for long vessel pedicles and larger flap areas to increase the flexibility of surgery.
探讨拇展肌岛状皮瓣上缘逆行动脉弓的血供情况，为该皮瓣修复前足皮肤缺损提供解剖学依据。
在12侧甲醛固定及12侧经红色乳胶灌注的新鲜成人足部标本上，观察拇展肌上缘动脉弓的组成、走行、分布、外径，以及伴行静脉和神经。设计采用拇展肌上缘动脉弓修复前足皮肤缺损的手术方法。
拇展肌上缘动脉弓由跗内侧动脉分支或内踝前动脉分支与拇趾内侧基底动脉浅支或足底内侧动脉浅支分支或上述4支全部吻合而成，是跗内侧、足内侧及足底内侧的轴心。内踝前动脉、跗内侧动脉、足底内侧动脉浅支分支及拇展肌上缘远侧动脉弓外径分别为（1.02±0.03）mm、（0.73±0.04）mm、（0.56±0.02）mm、（0.53±0.14）mm。多数动脉（91.67%）有1条伴行静脉，外径分别为（1.01±0.03）mm、（0.81±0.04）mm、（0.57±0.01）mm、（0.61±0.02）mm，少数（8.33%）有2条伴行静脉。
采用内踝前动脉分支、跗内侧动脉、足底内侧动脉浅支或三者联合供血的该皮瓣可修复前足皮肤缺损。第一跖骨颈或跖趾关节形成的旋转点可提供较长的血管蒂和较大的皮瓣面积，增加手术灵活性。
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