| OBJECTIVE:to provide the anatomic basis for the clinical use of the saphenous veno-neuro-fasciocutaneous flap on the medial foot and report its primary clinical application.METHODS:thirty human cadavers were used for this anatomic study.Each cadaver was injected with a mixture of red gelatin(nature rubber with red paint) with manual pressure through the popliteal arteries.After injection,we concentrated our dissection on the medial foot with the assistance of a magnification loupe(×5).0ur focus is to dissect and observe the major arteries on the medial foot,their anastomosis,nutritional vascular axis that accompany the saphenous nerve and the great saphenous vein and measure their length and exterior diameter.From July,2007 to November,2008,six flaps were harvested to repair the soft tissue defect at the forefoot.RESULTS:the great saphenous vein begins on the medial side of the foot and runs upward anterior to the medial malleolus receiving the majority of superficial veins of the foot.it have an obvious trunk with an average exterior diameter of(5.21±0.27) mm during its course on the medial foot with an axis as a line drawn from the tip of medial malleolus to the end of first toe.The cutaneous nerve on the medial foot is the terminal continuation of the saphenous nerve.The diameter at the intermalleolus line is(2.10±0.25)mm.It escorts the great saphenous vein during its course and often gives off 1-3 branches.The constant nutritional arteries of the great saphenous vein-saphenous nerve on the medial foot:①Perforator at medial side of the tendon of the tibialis anterior,it is(2.27±0.43) cm distal to the intermalleolar line.it passes across the medial side of the tendon of the tibialis anterior and pierces the deep fascia between the upper and lower bundle of the inferior extensor retinaculum with a diameter of(0.72±0.04)mm;The length of it after piercing the deep fascia is(7.3±0.6) mm,It has an emerging rate of 95%;②Perforator between tendons,it is (3.02±0.39) cm distal to the intermalleolar line;it pierces the deep fascia between the tendons of tibialis anterior and extensor digitorum longus with a diameter of (0.57±0.06)mm;The length of it after piercing the deep fascia is(7.4±0.6) mm.It has an emerging rate of 94%;③A constant distal fascial perforator pierces the deep fascia between abductor hallucis muscle and medial side of first metatarsal bone(1.97±0.23) mm distal to the first metatarsophalangeal joint with a diameter of(0.50±0.03)mm.The length of it after piercing the deep fascia is(6.5±0.5 )mm.It has an emerging rate of 100%.Among six patients receiving reconstruction of the wound at forefoot with the saphenous veno-neuro-fasciocutaneous flap,Case 1 developed skin necrosis about the size of 2cm×3cm,which healed with dressing change;the flap of case 2 and 3 was slightly dark,congested and developed tension blisters 24 hours after the operation,we administered the herbal medicine:Huo Xue Ti Qi Tang to the two patients,which was proved to be very effective for the conditions of both flaps were significantly improved.Other cases healed uneventfully.CONCLUSION:there are longitudinal vascular networks interweaved inside and around the great saphenous vein and saphenous nerve on the medial foot.These nutritional vessels give off branches not only to the great saphenous vein and saphenous nerve but also to the skin around the nerve.The saphenous veno-neuro-fasciocutaneous flap has advantages as follows reliable blood supply,similar texture and thinness to the skin of forefoot,adjacent transfer,short operative duration,minimal intra-operative blood loss.So The saphenous veno-neuro-fasciocutaneous flap is one of the preferable ways to reconstruct the soft-tissue defect at the forefoot.
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