游离母趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指的显微外科解剖
肖湘君,刘鸣江,廖辉文,刘昌雄,王郑钢,黄新锋,黄雄杰
中国临床解剖学杂志 ›› 2017, Vol. 35 ›› Issue (3) : 245-248.
游离母趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指的显微外科解剖
Study on applied anatomy of free hallux nail flap of second toe chimeric composite flap for thumb reconstruction
目的 为游离母趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指术提供解剖学基础。 方法 10只新鲜成人尸体足标本,经动脉灌注红色乳胶后进行解剖。系统观测母趾和第2趾动、静脉分布规律,测量血管长度及直径;模拟游离踇趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指的术式设计。 结果 第1跖背动脉在第1趾蹼深层发出2分支:踇趾腓侧趾底固有动脉和第2趾胫侧趾底固有动脉。踇趾腓侧趾底动脉血管(分叉至进入皮瓣)长度(1.82±0.12)cm,直径(1.08±0.06)mm;第2趾胫侧趾底动脉血管(分叉至近侧趾间关节)长度(0.90±0.16)cm,直径(0.82±0.13)mm。静脉分深浅两层,第1、2趾背侧浅静脉汇流入足踝内侧的大隐静脉。模拟再造拇指相互环绕的血管蒂无卡压。 结论 母趾、第2趾动、静脉血管可保障母趾甲皮瓣、第2趾骨复合组织瓣血供,模拟再造拇指相互环绕的血管蒂无卡压;适合设计游离母趾甲皮瓣嵌合第2趾骨复合组织瓣再造拇指。
Objective To provide the anatomical basis for free hallux chimeric 2nd toe nail skin flap for composite tissue flap for thumb reconstruction. Methods 10 fresh cadaveric foot specimens were dissected after perfusion with red latex. Systematic observation of hallux toe and 2nd toe arterial and venous distribution was performed, and the length and diameter were measured; Free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb operation design was simulated. Results 1st dorsal metatarsal artery in the 1th toes web space deep issued 2nd branches: the lateral plantar proper artery of Hallux the medial plantar proper artery of the second toe. The lateral plantar proper artery of Hallux (Bifurcation into the flap) has a length of (1.82±0.12) cm, anda diameter of (1.08±0.06) mm; The medial plantar proper artery of the second toe has a length of (0.90±0.16) cm and diameter of (0.82±0.13) mm. Veins were located in two layers. The 1st and 2nd dorsal superficial veins drain into the saphenous vein at the medial aspect of the foot and ankle. The reconstructed thumb's vascular pedicle underwent no compression. Conclusions The arterial and venous vessels of the 1st and 2nd toes can provide the hallux 2nd toe nail skin flap and 2nd toe of composite tissue flap with blood supply. No compression will occur in the reconstructed thumb’s vascular pedicle. Suitable for design free hallux chimeric 2nd toe nail skin flap composite tissue flap for thumb.
Hallux nail flap / Chimeric tissue flap / 2nd toe / Microscopic anatomy
[1] 胥少汀, 葛宝丰, 徐印坎. 实用骨科学[M]. 3版. 北京:人民军医出版社, 2005:487.
[2] 李鹏, 曾志超, 欧治平, 等. 第二足趾联合第一足趾腓侧皮瓣移植加甲床扩大修饰性再造拇指25例[J]. 中华显微外科杂志, 2010, 33(1):57-58.
[3] 周礼荣, 丁任, 王伟, 等. 总结931例手外伤修复与再造的方法[J]. 中华手外科杂志, 2000, 16(3):164-166.
[4] 顾玉东, 陈德松, 张高孟,等. 足趾移植再造拇指、手指400例报告[J].中华手外科杂志, 1995,11(4):195-199.
[5] 程国良, 方光荣, 藩达德, 等. 不同程度拇、手指采用不同形式的足趾组织移植再造与修复[J]. 中华手外科杂志,1995,11(4):200-203.
[6] 侯瑞兴, 王海文, 冯连银. 第二趾甲皮瓣修复手指皮肤脱套伤[J]. 中华显微外科杂志, 2000, 23(4): 271-273.
[7] 胡玉祥, 章峰火, 郭随林,等. 部分母甲瓣游离移植修复拇手指末节半侧缺损10例[J].中华显微外科杂志, 2011, 34(1):80-81.
[8] 张德军, 黎耀文, 伍美艺, 等. 应用部分母甲瓣急诊修复拇指末节缺损[J]. 中华显微外科杂志, 2013, 36(3):275-276.
[9] 候瑞兴, 王海文, 巨积辉, 等. 不同形式的第二趾甲皮瓣移植修复不同程度的手指皮肤脱套伤[J]. 中华手外科杂志, 2005, 21(3)142-144.
[10]刘亚平, 程国良, 丁小珩, 等. 带翼状皮瓣的第二趾甲瓣修复手指皮肤套脱伤[J]. 中华手外科杂志, 2006, 22(2): 73-74.
[11]牟勇, 黄东, 吴伟炽, 等. 改形母趾甲皮瓣与第2足趾联合移植再造拇指术的解剖学基础[J]. 中国临床解剖学杂志, 2010,28(2):131-134.
[12]牟勇, 黄东, 吴伟炽, 等. 以母趾背动脉为血供的趾背皮瓣应用解剖[J]. 中国临床解剖学杂志, 2010, 28(6): 618-619.
[13]廖观祥, 巨积辉, 刘新益, 等. 双侧(足母)趾皮瓣瓦合修复拇指套脱伤可行性的初步探索[J]. 中国临床解剖学杂志, 2013, 31(6): 650-654.
[14]李秀平, 巨积辉, 刘新益, 等. 吻合血管的趾甲移植修复拇、手指指甲缺损[J]. 中国临床解剖学杂志, 2013, 31(2): 210-213.
[15]Wang L, Fu J, Li M, et al. Repair of hand defects by transfer of free tissue flaps from toes[J]. Arch Orthop Trauma Surg, 2013,133(1):141-146.
[16] Yan H, Persons B, Gao W, et al. Nail flaps for microsurgical aesthetic reconstruction of thumb and donor site of great toe[J]. J Plast Surg Hand Surg, 2012,46(3-4):212-214.
[17] 程国良. 足趾移植再造拇指和手指外形的修饰理念[J]. 中华显微外科杂志, 2009, 32(1):92-94.
[18] 徐传达. 指部皮肤缺损修复术式的选择[J]. 中华手外科杂志, 2013, 29(2):65-66.
湖南省科技计划项目(2015SK20472)
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