Anatomical Basis And Clinical Application Of Dorsal Perforating Flap Of Plantar Arch

Objective:1.To observe the anatomical characteristics of the plantar arch dorsal perforator / intermediate dorsal cutaneous nerve and its nutrient vessels,which provides anatomical basis for design the plantar arch dorsal perforator flap/perforator-based intermediate dorsal pedal neurocutaneous vascular flap.2.To investigate the clinical application of plantar arch dorsal perforator flap and perforator-based intermediate dorsal pedal neurocutaneous vascular flap.Methods:1.Microsurgical dissection: Sixty-three sides of adult lower limb specimens transfused with intra-arterial red latex were selected.Giant microanatomy,vascular casting,and simulated surgery technology,the following observations were made:(1)The origin,walking,branching,and anastomosis of the dorsal perforator of the plantar arch;(2)The walking and distribution of Intermediate dorsal cutaneous nerve,anastomosis of the third dorsal perforating plantar arch and the intermediate dorsal pedal neurocutaneous vascular.Take pictures of anatomical samples,collect data and perform statistical analysis..Take pictures of anatomical samples,collect data and perform statistical analysis.2.Clinical application: According to the surgical anatomy data,7 cases were collected from February 2016 to December 2017,and plantar arch dorsal perforator flap and perforator-based intermediate dorsal pedal neurocutaneous vascular flap.The flap was used to repair the defect of the skin and soft tissue of the forefoot.The clinical pictures were taken,followed up and evaluated.Results:1.There are 3 foot dorsal perforators of the plantar arch,which pass through the 2nd to 4th interosseous dorsal muscles to the dorsal part of the foot and were divided into two groups: ascending and descending.The ascending branch and the dorsal anastomosis were descended and the descending branch was continued to 2 to 4 Dorsal artery.The starting diameters of the dorsal perforating branches of the foot arches 1 to 3 were(1.5±0.3)mm,(1.1±0.4)mm,(0.9±0.3)mm,respectively,and the lengths of the trunks were(1.1±0.2)cm,(1.5 ± 0.1)cm,(1.5 ± 0.5)cm.The dorsal medial cutaneous nerve was mainly a continuation of the lateral branch of the superficial temporal nerve,and it passeed through the surface of the cruciate ligament and goes straight to the proximal part of the fourth metatarsal space.It was divided into the posterior branches of the third and fourth tendons,and was distributed on part of the dorsal and dorsal skin;The dorsal medullary cutaneous neurotrophic vessels are multi-segmented and multi-sourced,and the proximal fourth metatarsal space,which is closely related to the surgical approach,has a relatively constant position of the third dorsal perforator at the proximal end of the plantar arch,and was divided into numerous small ones.The blood vessels were closely matched with the branches of the intermediate dorsal cutaneous nerve or paraneoplastic blood vessel chains.2.Application of plantar arch dorsal perforator flap for repair of soft tissue defect of forefoot application of plantar arch dorsal perforator flap to repair soft tissue defect of forefoot are 4 cases.Three cases of soft tissue defect of the forefoot repaired by perforator-based intermediate dorsal pedal neurocutaneous vascular flap.All the flaps survived.After 2 to 24 months of follow-up,the wounds healed well and the abrasion resistance was good.The patients were satisfied with the results of the surgery.Among them,the patients with cutaneous nerve nutrient vascular flaps recovered well.Conclusion:1.The rate of plantar arch dorsal perforators is high,the point of perforation is constant,and is consistent with a vascular body such as the lateral iliac artery,distal lateral iliac artery,and arcuate artery.It participate in the composition of the dorsal artery network,distributed in the dorsal skin.Plantar arch dorsal perforator branch as the pedicle,can be formed foot flap transposition or V-Y to promote the repair of foot or forefoot soft tissue defects.With the third plantar dorsal perforator of the plantar arch as the pedicle,the Intermediate dorsal cutaneous nerve is designed into the skin flap,and the dorsal mid-cutaneous neurocutaneous vascular flap can be formed with the third dorsal perforating branch of the plantar arch.Repair forefoot soft tissue defect.2.Blood supply plantar arch dorsal perforator is reliable,not involving the main blood vessels and venous return unobstructed.The supply and receiving areas are at the same foot,and the skin quality is equivalent to that of the defect.The operation is simple,safe and reliable.The flap is taken from the back of the foot and is not in the weight-bearing area.It do not affects the function of the foot after operation,and keeps the dorsal medial cutaneous nerve in the flap.The flap can be designed as a sensory flap and reduce the incidence of ulceration due to friction.