The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap
The medial malleolar network: A constant vascular base of the distally based saphenous neurocutaneous island flap
复制标题
内踝网络：远端隐神经皮岛瓣的恒定血管基底
DOI：
10.1007/bf01631327
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发表时间：
1999
影响因子：
1.4
通讯作者：
A. Masquelet
中科院分区：
文献类型：
--
作者：
F. Ballmer;R. Hertel;H. Noetzli;A. Masquelet
本文在30例新鲜尸体解剖的基础上，对内踝神经网进行了详细的解剖学研究，特别注意了内踝神经网与隐神经血管轴之间的吻合。内踝动脉网由内踝前动脉、跗内侧动脉分支、内踝后动脉和足底内侧动脉分支组成。一个明显的内踝前动脉和内踝后动脉可以分别在80%和20%，以及恒定的额外的小分支，从胫前或胫后动脉。跗内侧动脉弓与足底内侧动脉有恒定吻合。足底内侧动脉内侧分支的出现率为40%。这种吻合总是产生分支的内踝网络。在踝周区和大隐静脉，分别有100%和90%的隐神经前分支较大，后分支较小。在所有的解剖中，隐神经的两个分支在内踝网络和神经周围血管轴之间发现了两到四个小的但明显的血管瘤。这些恒定的动脉瘤为隐神经营养血管远端蒂岛状皮瓣提供了一个新的可靠的血管基础。因此，皮瓣的枢轴点可以选择在内踝区域，而不考虑神经周围血管轴和胫后动脉之间的最远端隔皮吻合。此外，一个说明性的临床病例。
Based on 30 fresh cadaver dissections a detailed anatomic study of the medial malleolar network is presented with particular attention to the anastomoses between the latter and the vascular axis that follows the saphenous nerve. The medial malleolar network is formed by the anterior medial malleolar artery, branches from the medial tarsal arteries, the posterior medial malleolar artery and branches from the medial plantar artery. A distinct anterior medial malleolar artery and posterior medial malleolar artery could be identified in 80 and 20%, respectively, as well as constant additional small branches arising from the anterior tibial or posterior tibial artery. A constant anastomosis was found between the arcade formed by the medial tarsal arteries and the medial plantar a. in 60%, and the medial branch of the medial plantar artery in 40%, respectively. This anastomosis always gave rise to branches to the medial malleolar network. In the perimalleolar area and with regard to the great saphenous v. a larger anterior and a smaller posterior branch of the saphenous nerve was found in 100 and 90%, respectively. In all dissections, for both branches of the saphenous nerve two to four small, but distinct anastomoses between the medial malleolar network and the perineural vascular axis were identified. These constant anastomoses represent a new and reliable vascular base for the distally-based saphenous neurocutaneous island flap. Thus, the pivotal point of the flap can be chosen in the area of the medial malleolus without respecting the most distal septocutaneous anastomosis between the perineural vascular axis and the posterior tibial artery. Additionally, an illustrative clinical case is presented.