Anatomic study on medialis pedis flaps with saphenous nerve and repairing tissue defects adjacent to Achilles tendon
- VernacularTitle:隐神经支配足内侧皮瓣的解剖学观察及其对跟腱周围组织缺损的修复
- Author:
Zairong WEI
;
Dali WANG
;
Yuming WANG
;
Jianping QI
;
Guangfeng SUN
;
Bo WANG
;
Xiujun TANG
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2008;12(40):7971-7974
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: Medialis pedis flaps have been widely used in the clinical practice due to their good color and luster,texture as well as the restoration of protective sensation. But little is known about the precise anatomic data of innervation of medialis pedis flaps.OBJECTIVE: Based on identification of local anatomic relationship, this study was designed to repair tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve and observe the repairing effects.DESIGN: A single-sample study.SETTING: Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College & Department of Anatomy, Zunyi Medical and Pharmaceutical College.PARTICIPANTS: Eleven patients with defects at Achilles tendon and/or local skin, who received treatment in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College between January 2004 and June 2007, were recruited into the present study. These patients, composed of 7 males and 4 females, were aged 15-40 years.METHODS: This experiment was performed at the Department of Anatomy, Zunyi Medical and Pharmaceutical College between January 2004 and June 2007. Twenty specimens of lower limb were from 12 cadavers obtained in the Department of Anatomy, Zunyi Medical and Pharmaceutical College and from 8 amputated extremities in the Department of Plastic Surgery,Affiliated Hospital of Zunyi Medical College (Informed consents for the application of amputated extremities have been acquired from the patients). The 20 specimens of adult lower limb were perfused with red emulsion to anatomically study the origin, course, number, size and distribution of the medial plantar artery and the number and distribution of the saphenous nerve in the medial malleolus. Concurrently, repair of tissue defects adjacent to Achilles tendon using medialis pedis flaps with saphenous nerve was performed in 11 patients in the Department of Plastic Surgery, Affiliated Hospital of Zunyi Medical College. Pedicle skin flaps were used in the 11 patients by transplantation.The Hospital's Ethics Committee approved the following protocol. After surgery, 1 24-month follow-up observation was performed by further consultation to study the color and luster, and the texture of the flaps, as well as the two-point discrimination difference compared with the opposite medial plantar area.MAIN OUTCOME MEASURES: Vascular nerves, which dominate medialis pedis flaps with saphenous nerve, as well as the appearance and function of these flaps after repairing tissue defects adjacent to Achilles tendon.RESULTS: Anatomic observation results: 1.0- 2.0 cm after its origin, the medial plantar artery divided into a superficial and a deep branch. The superficial branch of the medial plantar artery passed through the abductor muscle of great toe and originated around the tuberosity of navicular bone with an outer diameter of (1.0± 0.2) mm (adult). The deep branch was the direct continuation of the medial plantar artery, with an outer diameter of (1.5±0.3) mm (adult). 2.5-5.0 cm away from the medial plantar artery, the deep branch divided into a medial deep and a lateral deep branch. The medial deep branch passed through the abductor muscle of great toe deeply and sub-divided into the medial branch (cutaneous branch) and the lateral branch at the branching point of the medial and lateral deep branches. Clinical application: Altogether 11 flaps were used in the present study. All flaps were successfully transplanted without early vascular risk or flap necrosis. Among 7 patients followed up, 2 were followed up for I month, 3 for 6 months, 1 for I year, and I for 2 years. Follow up results showed that the transplanted flaps had good color and luster, texture, and appearance. There was no difference in two-point discrimination between the flap and the opposite medial plantar area.CONCLUSION: Medialis pedis flaps is blood-supplied by the superficial branch of the medial plantar artery that is an absolutely dominated area of the saphenous nerve. Medialis pedis flaps with saphenous nerve can repair Achilles tendon and adjacent tissue defects, possessing the advantages of less anatomic variation, easy resection, and good repair effects.
