The Anatomical Basis And Clinical Application Of Free Medial Phantar Cutaneous Branch Flap

Objective:1,to sum up the quantity, length, origin, course, distribution and ouside diameter of cutaneous branch of medial plantar artery which were sent out to the non weight area of medial plantar2,to sum up the operation method and clinical effect of free medial plantar cutaneous branch flap pedicled cutaneous branch of medial plantar artery in repairing wound of finger palmMethods:1,The quantity, length, origin, course, distribution and ouside diameter of the cutaneous branch of medial plantar artery which were sent out to the non weight area of medial plantar were observed by infusing red emulsion into theposterior tibial arteries or the peroneal arteries in 5 adult cadaveric specimens. We use vernier caliper to measure the quantity and ouside diameter of cutaneous branch2,11 patients misdignosed with wound of finger palm, three of these are the defect of thumb, three of these are the defect of index finger, three of these are the defect of middle finger;one of these are the defect of ring finger; one of these is the defect of little finger. all of these case are crush injury, the defection range of skin is 2.0cm×3.0cm-3.0cm×5.0 cm, the time from injury to operation is 2-10 h, the average time is 4h, we used free medial plantar cutaneous branch flap to repair the defection, seven of these carry branch nerve, four of these do not carry branch nerve.the size range of these cutaneous branch flap is 2.5 cm×3.5 cm-3.5cm×5.0 cm, the cutaneous branch of medial plantar artery anastomosis with recipient digital artery, the cutaneous branch of medial plantar nerve anastomosis with recipient digital nerve or dorsal nerve, the superficial vein or accompanying vein of flap anastomosis with recipient dorsal vein. donor area are direct sutured or skin graftedResults:1,Posterior tibial artery from the Split ligament divide into medial plantar artery and lateral plantar artery in the starting of the abductor hallucis muscle, the medial plantar artery and lateral plantar artery pass the deep area of the abductor hallucis muscle. the medial plantar artery run into the medial part of foot plantar. the lateral plantar artery run into the lateral of the foot from the deep area of flexor digitorum brevis muscle.2,The medial plantar artery divided into deep branch and Superficial branch near the Medial plantar intermuscular septum, the deep branch run into the lateral area of foot, send out muscle branch artery to supply abductor hallucis muscle and send out branches to foot dorsum and constituted the deep arch plantar. then the superficial branch divided into medial branch and medial superficial arch near the Medial plantar intermuscular septum.3,The medial branch of the superficial branch of medial plantar artery pass through the Medial plantar intermuscular septum,and to the surface in the end of head of metatarsal bone near the medial part of Medial plantar intermuscular septum,and anastomosis to the first Metatarsal bottom artery,and the to the tibial of toe. Superficial branch near the lateral part of Medial plantar intermuscular septum to the anterolateral send out 3 branches and the branches import the the first Metatarsal bottom artery, the second Metatarsal bottom artery and the third Metatarsal bottom artery4,Medial branch and medial superficial arch of medial plantar artery send out 9-10 cutaneous branches from the two sides of Medial plantar intermuscular septum to the non weight area of medial plantar, the average length from the starting part to deep fascia is 0.68cm, the average length from deep fascia to derma is 0.44cm,the average outside diameter is 0.45mm.5,All 11 cases were applied successfully with the transplanted flap including grafting and the direct area,6-10 months later, the texture and appearance and touch are satisfied, Discrimination of two points is 7-9 mm. which carry nerve, Discrimination of two points is 10-12 mm. which do not carry nerveConclusion:1,Posterior tibial artery from the Split ligament divide into medial plantar artery and lateral plantar artery in the starting of the abductor hallucis muscle, The medial plantar artery divided into deep branch and Superficial branch near the Medial plantar intermuscular septum, then the superficial branch divided into medial branch and medial superficial arch branch, the deep branch run into the lateral area of foot and constituted the deep arch plantar.2,Medial branch and medial superficial arch of medial plantar artery send out 9-10 cutaneous branches from the two sides of Medial plantar intermuscular septum to the non weight area of medial plantar, the average length from the starting part to deep fascia is 0.68cm, the average length from deep fascia to derma is 0.44cm,the average outside diameter is 0.45mm3,There are many cutaneous branches which are sent out from the Medial branch and medial superficial arch of medial plantar artery to the non weight area of medial plantar, the near 1/3 branches are more, the length of vesselpedicle are more longer, the diameter are more thicker, they are fit for medial cutaneous branch flap.4,The cutaneous branch flap does not injure the main vessel, levels of anatomy is superficial, does not injure the deep tissue, donor area can be direct sutured 5,Free medial plantar cutaneous branch flap pedicled cutaneous branch of medial plantar artery in repairing wound of finger palm, the operation method is easy, donor area can be direct sutured mostly,and clinical effect is better.6,These study about the quantity, length, origin, course, distribution and ouside diameter of cutaneous branch of medial plantar artery which were sent out to the non weight area of medial plantar provided anatomic evidence the clinical application of medial cutaneous branch flap.