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目的观察足底内侧岛状皮瓣的血管、神经分布情况,探讨足底内侧岛状皮瓣顺行转移、逆行转移的设计方法,并指导临床治疗足底恶性肿瘤。方法观察16例甲醛固定成人尸体足及2例新鲜足的足底内侧血管、神经的分支、分布情况;观察足底内侧岛状皮瓣的血管、神经分支、分布情况。临床应用皮瓣修复16例足跟区和10例前足区恶性肿瘤切除后软组织缺损。结果足底内侧动脉的走行,分布有明显变异。足底内侧动脉浅支有2～3条皮支入足底内侧岛状皮瓣;深支有3～4个皮穿支入该皮瓣。以近侧端1、2支为主。静脉为与动脉同名的伴行静脉,口径均粗于动脉,均有2条足底内侧神经的皮支分布到该皮瓣。临床应用26例皮瓣成活良好,随访3个月～5年,皮瓣感觉及耐磨功能良好。结论足底内侧岛状皮瓣主要由足底内侧动脉浅支入该皮瓣的皮支营养。顺行转移时可在足底内、外侧动脉分叉点至第I跖骨头后方1 cm的点之间设计皮瓣,必要时需切断结扎足底内侧动脉深支以获得足够长度的蒂。逆行转移时,皮瓣尽可能的设计在近段,蒂部尽可能保留2～3个分支,以保障皮瓣的血供。
Objective To observe the distribution of blood vessels and nerves in the medial plantar island skin flap and to explore the design method of the parathyroid flap in the plantar migration and retrograde metastasis and to guide clinical treatment of plantar tumor. Methods 16 cases of formalin fixed adult cadaver feet and 2 cases of fresh foot medial vessels and nerves branches and distribution were observed. The vessels and nerve branches and distribution of the insular island skin flap were observed. Clinical application of flap repair 16 cases of heel and 10 cases of forefoot excision of soft tissue defects. Results The movement and distribution of the medial plantar artery had obvious variation. The superficial branches of the medial plantar artery have 2 ~ 3 skin branches into the medial plantar island flap; deep branch has 3 to 4 skin pierced into the flap. The proximal end of 1,2-based. Venous artery with the same name as the accompanying vein, the caliber are thicker than the artery, there are two branches of the medial nerve of the foot distributed to the skin flap. The clinical application of 26 cases of flaps survived well, followed up for 3 months to 5 years, flap feeling and good wear resistance. Conclusions The medial plantar island flap is mainly supported by the superficial branch of the medial plantar pedicel flap. In the forward transfer, the flap can be designed between the bifurcation of the medial and lateral branches of the foot to the point 1 cm behind the first metatarsal head. If necessary, the deep branch of the medial plantar artery should be cut to obtain a pedicle of sufficient length. Reverse retrograde, the flap design as close as possible, pedicle retained as much as possible 2 to 3 branches in order to protect the flap of the blood supply.