족배-제1증족동맥의 해부학적 연구(I)

Anatomic study of the dorsalis pedis-first dorsal metatarsal artery(I)

The dorsalis pedis flap is still a best choice in selected cases in spite of the advent of new flaps. However, the anatomic variation of its arterial axis, dorsalis pedis-first dorsal metatarsal artery, posed the technical problem in harvesting the flap and the controversy about its vascular reliability. This study was performed to investigate the vascular anatomy of the dorsalis pedis-first dorsal metatarsal artery with regard to its general distribution and variation, expecially focussed on the status of dorsalis pedis - first dorsal metatarsal - first plantar metatarsal arterial interconnection and the sagittal course of the first dorsal metatarsal artery, in order to give informations for the operating procedures and the understanding of the vascular reliability. Seventeen feet of 9 caucacian fixed cadavers were dissected after injection of dye or resin into the popliteal artery. The first dorsal metatarsal artery was always present. It was originated from the dorsalis pedis artery in 82.35% of cases, and the rest from the lateral tarsal artery. The critical point, where the first dorsal metatarsal artery or the first plantar metatarsal artery in case when the former was branched from the latter, was located 10mm distal to the tarsal-first metatarsal joint and 5.5mm plantar from the dorsal surface of the 2nd metatarsal bone. The medial head of the first dorsal interosseous muscle crossed dorsal to the first dorsal metatarsal artery in 58.82%. The first dorsal metatarsal artery coursed superficial to the first dorsal interosseous muscle(41.18%, Gilbert s type Ia), partially embedded with the muscle(29.41%, Gilbert s type Ib), or along the bottom of it or below(29.41%, Gilbert s typeⅡ). In the latter type, 3 out of 5 specimens showed thin arterial loop. The arterial network in the first interosseous space presented several anatomic variations. The standard pattern(GroupⅠ) was most frequent(70.59%). Other variations(GroupⅡ) could be further categorized as three subdivisions according to the pattern of the rterial interconnection.