From the Department of Plastic and Reconstructive Surgery, Yonsei University, College of Medicine, Severance Hospital; Department of Plastic and Reconstructive Surgery, Asan Medical Center, College of Medicine, University of Ulsan; and Department of Plastic and Reconstructive Surgery, University of British Columbia.
Plast Reconstr Surg. 2021 Aug 1;148(2):258e-261e. doi: 10.1097/PRS.0000000000008176.
Adequate arterial inflow is mandatory for a successful free tissue transfer. Maximizing this inflow appears to be especially important during distal lower extremity reconstruction, where perfusion pressures can be significantly lower than in the trunk or head and neck. In the current study, the authors used color and pulsed-wave Doppler ultrasonography to analyze blood flow volumes in the foot in accordance with the ankle position. Twenty feet of 10 healthy subjects were included in the analyses. All subjects were examined by Doppler ultrasonography at three different ankle angles (dorsiflexion at 90 degrees, relaxed position, and complete plantar flexion). The average flow volumes of the dorsalis pedis artery varied dramatically at the different ankle positions, as follows: dorsiflexion, 19.81 ± 3.88 ml/minute; relaxed position, 11.71 ± 4.72 ml/minute; and plantar flexion, 3.47 ± 1.41 ml/minute. The average flow volume of the posterior tibial artery also varied dramatically at these different ankle positions: dorsiflexion, 9.08 ± 8.25 ml/minute; relaxed position, 14.78 ± 2.45 ml/minute; and plantar flexion, 19.03 ± 5.03 ml/minute. The ankle position dramatically affects the flow velocity in the anterior and posterior tibial vessels, which is an important consideration when performing free tissue transfer reconstruction of the foot. Ankle dorsiflexion would be recommended when using the anterior tibial artery as a recipient vessel, whereas plantar flexion of the ankle would be advised when the posterior tibial artery is used as a recipient vessel.
足够的动脉流入是成功进行游离组织移植的必要条件。在远端下肢重建中，最大限度地增加这种流入似乎尤为重要，因为灌注压可能明显低于躯干或头颈部。在目前的研究中，作者使用彩色和脉冲波多普勒超声检查根据踝关节位置分析足部的血流容积。分析包括 10 名健康受试者的 20 只脚。所有受试者均通过多普勒超声检查在三个不同的踝关节角度（背屈 90 度、放松位置和完全跖屈）进行检查。背侧足弓动脉的平均血流容积在不同的踝关节位置差异很大，如下所示：背屈时为 19.81±3.88ml/min；放松位置时为 11.71±4.72ml/min；跖屈时为 3.47±1.41ml/min。后胫后动脉的平均血流容积在这些不同的踝关节位置也有很大差异：背屈时为 9.08±8.25ml/min；放松位置时为 14.78±2.45ml/min；跖屈时为 19.03±5.03ml/min。踝关节位置会显著影响前胫后血管的血流速度，这在进行足部游离组织移植重建时是一个重要的考虑因素。当使用胫骨前动脉作为受区血管时，建议踝关节背屈，而当使用胫骨后动脉作为受区血管时，建议踝关节跖屈。
