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目的介绍内踝后穿支筋膜皮下瓣的血管解剖基础与初步临床应用效果。方法解剖24侧新鲜下肢灌注标本,观察内踝后间隙内胫后动脉发出的穿支血管情况。临床切取内踝后穿支筋膜皮下瓣,翻转修复跟内侧创伤缺损5例。结果内踝后间隙长约4cm,前界为内踝及趾长屈肌腱,后方为跟腱,表面为深筋膜覆盖,间隙内有疏松脂肪组织。在内踝后间隙内走行的胫后动脉发出2~3条皮肤穿支血管,口径0.1～0.7 mm,一般小于0.5 mm,但数量恒定。内踝后穿支与上方的胫后动脉最远侧肌间隔穿支血管间有互补性,在筋膜表面和皮下组织中有丰富血管吻合。临床上以内踝后穿支血管为轴点(内踝最下缘上方1～2 cm),设计切取远端蒂筋膜皮下瓣,面积5～6 cm×6～12 cm,修复5例跟骨开放性骨折的内侧创面,筋膜瓣均成活。结论内踝后穿支筋膜皮下瓣相对传统的肌间隔穿支血管组织瓣,其旋转轴点下移,减少小腿供区损伤,无静脉回流障碍,受区组织柔软活动度好,更适合修复足跟内侧的创面。
Objective To introduce the basis of vascular anatomy and preliminary clinical application of subcutaneous flap of medial malleolus. Methods Fresh limb perfusion specimens of 24 sides were dissected and the perforating vessels in the posterior tibial artery in the posterior malleolus were observed. After the medial malleolus was cut off, the subcutaneous flap of the fascia was overturned, 5 cases were repaired and traumatic defect was repaired with the medial malleolus. Results The posterior malleolar gap was about 4 cm in length. The anterior and posterior medial malleolus and flexor flexor tendon were covered with a deep fascia covering the back, and loose adipose tissue in the gap. The posterior tibial artery that runs in the posterior malleolar space emits 2-3 skin perforating branches with a caliber of 0.1-0.7 mm, typically less than 0.5 mm but of a constant volume. The medial malleolar posterior commissure is superior to the distal posterior tibial artery superior intercostal perforating branch in the superior vessels, and has abundant vascular anastomosis in the fascia surface and subcutaneous tissue. Clinically, the posterior medial malleolus perforating branch is the axis point (1 ~ 2 cm above the lowermost edge of the medial malleolus). The subcutaneous flap of the distal pedicle fascia is designed and cut. The area is 5 ~ 6 cm × 6 ~ 12 cm. The internal fracture of the fracture, fascia flap are alive. Conclusions The posterior medial malleolus subfascial flap of submandibular foramen relative to the traditional muscular septal perforator branch with its axis of rotation moving downwards reduces the donor area injury of the calf and has no venous return disturbance. It is more suitable for repairing the foot With the inside of the wound.