小腿前内侧区穿支皮支链的应用解剖及穿支坐标化定位

doi:10.13418/j.issn.1001-165x.2026.1.05

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中国临床解剖学杂志 ›› 2026, Vol. 44 ›› Issue (1) : 28-34. DOI: 10.13418/j.issn.1001-165x.2026.1.05

应用解剖

小腿前内侧区穿支皮支链的应用解剖及穿支坐标化定位

郭子龙^1,3#，许康立^2#，余浩⁴，谭日东¹，戴慧婕¹，李奥赢¹，石富文¹，
彭田红¹*，谢巍¹*

作者信息 +

The applied anatomy and coordinate localization of the cutaneous branch chain in the anteromedial region of the lower leg

Guo Zilong^1,3#, Xu Kangli^2#, Yu Hao⁴, Tan Ridong¹, Dai Huijie¹, Li Aoying¹, Shi Fuwen¹, Peng Tianhong¹*, Xie Wei¹*

Author information +

文章历史 +

摘要

目的明确小腿前内侧区穿支皮支链的分布和形态，并对其进行坐标化定位，为小腿前内侧皮支链皮瓣临床应用提供解剖学依据。方法 18侧新鲜成人下肢标本，6侧行股动脉红色乳胶加氧化铅灌注，12侧行股动脉红色乳胶灌注。显微解剖18侧下肢标本，观测小腿前内侧区的皮支血管链，对构成该血管链且直径>0.2 mm的穿支的数量、起源、走行、直径等情况进行观测，通过建立小腿部坐标，以（± x，y）%的形式定位皮支穿出密集点的位置。6侧乳胶加氧化铅灌注的标本进行CT扫描，三维重建小腿前内侧区穿支皮支血管链。结果共统计参与构成小腿前内侧区皮支链的穿支76支，穿支穿深筋膜处的直径为（0.77±0.37） mm，于小腿前内侧区共形成5处较为稳定的密集穿出区。环腘窝连线总长度为（33.9±3.7） cm，后正中线总长度为（37.2±5.3） cm。胫后动脉各穿支穿出密集点位置由近端至远端依次为（-24.0±2.4，0.43±0.06） %、（-21.3±2.0，0.52±0.04） %、（-17.6±5.2，0.70±0.09） %、（-12.3±2.3，0.90±0.05） %，隐动脉于（-14.6±3.5，0.05±0.03）%处穿深筋膜后与胫后动脉穿支血管链相吻合，共同构成一条纵贯小腿前内侧区的皮支血管链，且经三维重建后该穿支血管链清晰可见。穿支穿出点位置进行坐标标准化定位后，较传统解剖学定位拥有更小的变异系数，且Y轴变异系数的对比结果显示P<0.05。结论明确了小腿前内侧区存在一条纵贯全长的穿支皮支链，其特点为扩大该区皮瓣切取范围及减少供区损伤提供了形态学依据。通过小腿前内侧区坐标化可使穿支穿出点的定位更加科学精准。

Abstract

Objective To provide an anatomical basis for the clinical application of the cutaneous branch chain flap in the anteromedial lower leg by clarifying its distribution and morphology, and establishing a standardized coordinate system for precise localization. Methods A total of 18 fresh adult cadaveric lower legs were used in the research. A total of 18 fresh adult lower extremity specimens were perfused with red latex plus lead oxide in the femoral artery on 6 sides and red latex in the femoral artery on 12 sides. Microdissection of 18 lateral lower leg specimens was performed to observe the cutaneous branches-chain in the anteromedial region of the lower leg, and the number, origin, course, and diameter of the perforator forming the cutaneous branch chain and having a diameter >0.2 mm were observed. The position of the dense point of cutaneous branch chain in the form of (±x, y) % was located by establishing the coordinate system of the lower leg. CT scan was performed in 6 specimens which were perfused with red latex and lead oxide, and three-dimensional reconstruction of the cutaneous branch chain of the anteromedial lower leg was performed. Results A total of 76 cutaneous perforators involved in forming cutaneous branch chain of the anteromedial lower leg in our study. The diameter of perforators at the deep fascia was (0.77±0.37) mm. Study demonstrated there were 5 cluster points of cutaneous clusters of cutaneous branch chain of the anteromedial lower leg. The total length of ring the popliteal fossa was (33.9±3.7) cm, and the total length of posterior midline of lower leg was (37.2±5.3) cm. Cluster points of cutaneous clusters of posterior tibial artery from the proximal end to the distal end was as follows, successively: (-24.0±2.4, 0.43±0.06) %, (-21.3±2.0, 0.52±0.04) %, (-17.6±5.2, 0.70±0.09) % and (-12.3±2.3, 0.90±0.05) %. The saphenous artery passed through the deep fascia in (-14.6±3.5，0.05±0.03) % and linked cutaneous branch chain of posterior tibial artery to form a cutaneous branches-chain vertical throughout anteromedial lower leg. The cutaneous branch chain was clearly visible after 3D reconstruction. The location of the penetration point of the perforator was standardized to have a smaller coefficient of variation than conventional anatomical positioning, and the comparison of the Y-axis coefficient of variation showed P<0.05. Conclusion The cutaneous branch chain is available to expand the range of skin flap and ensure safety for harvest of the flap. Standardizing location was more accurate and scientific than traditional anatomical location.

导出引用

郭子龙, 许康立, 余浩, 谭日东, 戴慧婕, 李奥赢, 石富文, 彭田红, 谢巍. 小腿前内侧区穿支皮支链的应用解剖及穿支坐标化定位[J]. 中国临床解剖学杂志. 2026, 44(1): 28-34 https://doi.org/10.13418/j.issn.1001-165x.2026.1.05

Guo Zilong, Xu Kangli, Yu Hao, Tan Ridong, Dai Huijie, Li Aoying, Shi Fuwen, Peng Tianhong, Xie Wei. The applied anatomy and coordinate localization of the cutaneous branch chain in the anteromedial region of the lower leg[J]. Chinese Journal of Clinical Anatomy. 2026, 44(1): 28-34 https://doi.org/10.13418/j.issn.1001-165x.2026.1.05

中图分类号： R323.72

参考文献

[1] 徐丹, 刘鹏, 郑雪峰, 等. 尺动脉腕上皮支降支小鱼际皮瓣的解剖学基础[J]. 中国临床解剖学杂志, 2021, 39(4):4. DOI:10.13418/j.issn.1001-165x.2021.04.006.
Xu D, Liu P, Zheng XF, et al. Anatomical basis of hypothenar skin flap based on descending branches of supracarpal cutaneousbranch of the ulnar artery [J]. Chin J Clin Anat, 2021, 39(4):4. DOI:10.13418/j.issn.1001-165x.2021.04.006.
[2] 刘梦清, 刘志德, 杨慧广, 等. 鱼际桡侧皮支链带蒂皮瓣在修复示中环指皮肤缺损中的临床应用[J].实用手外科杂志, 2020, 34(4): 425-427,436. DOI:10.3969/j.issn.1671-2722.2020.04.018.
Liu MQ, Liu ZD, Yang HG, et al. Clinical application of pedicled skin flap with radial branch chain of the nar to repair the skin defect of index middle and ring finger [J]. J Prac Hand Surg, 2020, 34(4):425-427, 436. DOI:10.3969/j.issn.1671-2722.2020.04.018.
[3] Lee JT, Cheng LF, Wu MS, et al. Reconstruction of Diabetic Foot Defects With the Proximal Lateral Leg Perforator Flap[J]. Ann Plast Surg, 2019, 82(5): 546-551. DOI:10.1097/SAP.0000000000001745.
[4] Hupkens P, Schijns W, Van AM, et al. Lateral lower leg perforator flaps: an anatomical study to localize and classify lateral lower leg perforators[J].Microsurgery,2015,35(2):140-147. DOI:10.1002/micr. 22313.
[5] 梅劲, 任家武, 楼新法, 等. 小腿部主要穿支的形态学分析与皮瓣设计[J]. 中国临床解剖学杂志, 2006, 24(3): 251-254. DOI:10.3969/j.issn.1001-165X.2006.03.008.
Mei J, Ren JW, Lou XF, et al. Morphometric analysis and flap design of the vascular perforators of the calf [J]. Chin J Clin Anat, 2006, 24(3): 251-254. DOI:10.3969/j.issn.1001-165X.2006.03.008.
[6] Yu D, Hou Q, Liu A, et al. Delineation the anatomy of posterior tibial artery perforator flaps using human cadavers with a modified technique[J]. Surg Radiol Anat, 2016, 38(9): 1075-1081. DOI:10.1007/s00276-016-1671-4.
[7] Mashrah MA, Mai L, Wan Q, et al. Chimeric posterior tibial artery flap: clinical application in oral and maxillofacial reconstruction[J]. Int J Oral Maxillofac Surg, 2020, 49(8): 993-999. DOI:10.1016/j.ijom. 2019. 12.008.
[8] 王国忠, 吴翮, 董全宇, 等.游离胫后动脉穿支皮瓣修复前足软组织缺损13例[J]. 中华显微外科杂志, 2022, 45(3): 266-270. DOI:10.3760/cma.j.cn441206-20211206-00287.
Wang GZ, Wu H, Dong QY, et al. Repair of soft tissue defect of forefoot with free posterior tibial artery perforator flap: Report of 13 cases [J]. Chin J Microsurg, 2022, 45(3): 266-270. DOI:10.3760/cma.j.cn441206-20211206-00287.
[9] 汪坤菊, 石小田, 丁自海, 等. 胫后动脉皮支链皮瓣的应用解剖[J]. 中华显微外科杂志, 2019, 42(4): 366-370. DOI:10.3760/cma.j.issn.1001-2036.2019.04.012.
Wang KJ, Shi XT, Ding ZH, et al. The applied anatomy of posterior tibial artery cutaneous branches-chain flap [J]. Chin J Microsurg, 2019,42(4): 366-370. DOI:10.3760/cma.j.issn.1001-2036.2019.04.012.
[10]Wu WC, Chang YP, So YC, et al. The anatomic basis and clinical applications of flaps based on the posterior tibial vessels[J]. Br J Plast Surg, 1993, 46(6): 470-479. DOI: 10.1016/0007-1226(93)90220-6.
[11] 劳杰, 熊良俭, 顾玉东, 等. 肌间隙血管为蒂小腿内侧皮瓣的应用解剖及临床应用[J]. 中国临床解剖学杂志, 2002, 20(1): 71-72. DOI:10.3969/j.issn.1001-165X.2002.01.026.
Lao J, Xiong LJ, Gu YD, et al. Applied anatomy of the lower medial leg fasciocutaneous flap pedicled with the intermuscular branch of the posterior tibial artery and its clinical significance [J]. Chin J Clin Anat, 2002, 20(1): 71-72. DOI: 10.3969/j.issn.1001-165X.2002.01.026.
[12] 秦向征, 刘鹏, 许东元, 等. 腓浅动脉皮支链的应用解剖[J].中华显微外科杂志, 2015, 38(1):66-69. DOI:10.3760/cma.j.issn.1001-2036. 2015. 01.016.
Qin XZ, Liu P, Xu DY, et al. Anatomic study of branches-chain base on the superficial peroneal artery [J]. Chin J Microsurg, 2015, 38(1): 66-69. DOI:10.3760/cma.j.issn.1001-2036.2015.01.016.
[13] 汪坤菊, 石小田, 丁自海, 等. 腓动脉皮支链皮瓣的应用解剖[J].解剖学杂志, 2020, 43(4): 309-312. DOI:10.3969/j.issn.1001-1633.2020.04. 008.
Wang KJ, Shi XT, Ding ZH, et al. Applied anatomy of cutaneous branches-chain flap of the peroneal artery [J].Chi J Anat, 2020, 43(4):309-312. DOI:10.3969/j.issn.1001-1633.2020.04.008.
[14] 徐象党, 戴开宇, 周鹏, 等. 小腿后部各区穿支间的关系与皮瓣设计[J]. 中华显微外科杂志, 2009, 32(3): 190-192.DOI:10.3760/cma.j.issn.1001-2036.2009.03.008.
Xu XD, Dai KY, Zhou P, et al. Relationship and flap design on the perforators of the posterior leg [J]. Chin J Microsurg, 2009, 32(3):190-192. DOI:10.3760/cma.j.issn.1001-2036.2009.03.008.
[15] 邝艺臻, 黄东, 兰万利, 等.胫后动脉穿支皮瓣设计的应用解剖[J].中国临床解剖学杂志, 2017, 35(3): 252-255. DOI:10.13418/j.issn.1001-165x.2017.03.004.
Kuang YZ, Huang D, Lan WL, et al. An anatomic study on design of the posterior tibial artery perforator flap [J]. Chin J Clin Anat, 2017, 35(3): 252-255. DOI:10.13418/j.issn.1001-165x.2017.03.004.
[16] 徐强, 王镖, 张锡平, 等. 低旋转点胫后动脉穿支蒂隐神经-大隐静脉营养血管皮瓣的临床应用[J]. 中华显微外科杂志, 2021, 44(1): 74-76.DOI:10.3760/cma.j.cn.441206-20191216-00385.
Xu Q, Wang B, Zhang XP, et al. Clinical Application of the Low Pivot Point Posterior Tibial Artery Perforator Pedicled Saphenous Neuro-Venous Nutrient Flap [J]. Chin J Microsurg, 2021, 44(1): 74-76. DOI:10.3760/cma.j.cn.441206-20191216-00385.
[17]Zhong W, Lu S, Wang C, et al. Single perforator greater saphenous neuro-veno-fasciocutaneous propeller flaps for lower extremity reconstructions[J]. ANZ J Surg, 2017, 87(7-8). DOI:10.1111/ans.13065.
[18]熊涛, 周伟.皮支链皮瓣在手指创伤软组织缺损修复中的应用效果[J].中华骨与关节外科杂志, 2020,13(6):497-500. DOI:10.3969/j.issn.2095-9958.2020.06.12.
Xiong T, Zhou W. Effect of skin branch chain flaps in repairing soft tissue defect of finger trauma[J]. Chinese Journal Bone and Joint Surgery, 2020, 13(6): 497-500. DOI:10.3969/j.issn.2095-9958.2020.06. 12.
[19] 李楚炎, 朱小弟, 李文庆, 等. 指背皮支链皮瓣修复手指背侧组织缺损的临床应用[J]. 中国临床解剖学杂志, 2019, 37(2): 210-212. DOI:10.13418/j.issn.1001-165x.2019.02.019.
Li CY, Zhu XD, Li WQ, et al. Clinical application of dorsal cutaneous branch-chain flaps in repairing dorsal skin defects of the finger [J]. Chin J Clin Anat, 2019, 37(2): 210-212. DOI:10.13418/j.issn.1001-165x.2019.02.019.
[20] 毛仁群, 王培吉, 李文庆, 等.同指筋膜蒂指动脉皮支链皮瓣修复指端软组织缺损[J].中华手外科杂志, 2019, 35(3):189-191. DOI:10.3760/cma.j.issn.1005-054X.2019.03.010.
Mao RQ, Wang PJ, Li WQ, et al. Clinical application of fascial pedicle digital artery cutaneous branch chain flap of the same finger for repair of soft tissue defects of fingertip [J]. Chin J Hand Surg, 2019, 35(3):189-191. DOI:10.3760/cma.j.issn.1005-054X.2019.03.010.