带腓肠外侧皮神经及其营养血管筋膜皮瓣的应用解剖

目的 为带腓肠外侧皮神经及其营养血管筋膜皮瓣的临床应用提供解剖学基础.方法 在32例成人下肢标本上,对腓肠外侧皮神经及其营养血管进行解剖观测.结果 腓肠外侧皮神经在腓骨头平面上方 7.1±2.4cm处起于腓总神经,分布于小腿后外侧上半或上2/3的皮肤.其营养动脉主要为:腓肠外侧皮动脉:起自腘动脉,在腓骨头平面上方5.0±1.5cm处浅出,外径为0.9±0.3mm;肌间隔筋膜皮支:起自胫后动脉和腓动脉,分别在腓骨头平面下方9.2±3.8cm和15.8±3.8cm处浅出,外径为0.7±0.3mm和0.9±0.4mm.该营养动脉除在腓肠外侧皮神经周围或其内呈链式吻合外,还发出筋膜皮支与邻位的皮动脉连接.静脉血可沿伴行静脉或小隐静脉及其属支回流至深静脉.结论 以腓肠外侧皮神经及其营养血管为蒂,可设计成顺行或逆行转位筋膜皮瓣,修复邻近部位的软组织缺损.     

腓肠神经营养血管蒂岛状皮瓣的应用解剖

目的 :为带腓肠神经营养血管蒂岛状皮瓣的临床应用提供解剖学依据。方法 :在 3 8侧经动脉灌注红色乳胶成人下肢标本上解剖观测腓肠神经及营养血管的起始、走行、分支分布、吻合及外径 ,2侧成人新鲜下肢标本墨汁灌注观察营养血管的墨染范围。结果 :腓肠神经由腓肠内侧皮神经与腓神经交通支汇合而成 ,其汇合点在外踝上 12 .7± 3 .7cm ,腓肠神经沿窝中点至外踝与跟腱中点连线下行 ,外踝上 12 .6± 3 .4cm处穿出深筋膜。其营养血管主要来源于窝中间皮动脉和腓动脉肌间隔穿支 ,上段起始部外径 0 .6± 0 .1mm ,下段距外踝上 6.7± 1.6cm处与腓动脉穿支恒定吻合 ,吻合支外径 0 .6± 0 .1mm ,沿途发出众多筋膜皮支营养小腿后部皮肤。结论 :以腓肠神经及其营养血管为蒂可设计切取顺行或逆行岛状皮瓣。     

带腓肠外侧皮神经及其营养血管筋膜皮瓣的应用解剖

<正> 为带腓肠外侧皮神经及其营养血管筋膜皮瓣的临床应用提供解剖学基础.在32侧成人下肢标本上,对腓肠外侧皮神经及其营养血管进行解剖观测.结果:腓肠外侧皮神经在腓骨头平面上方(7.l±2.4)cm处起于腓总神经,横径为(2.6±1.0)mm,沿腘窝及小腿后外侧面下行,腓骨头平面的横径为(3.0±0.9)mm,发出1-3个终支,分布于小腿后外侧上半或上2/3的皮肤.其营养动脉主要为:①腓肠外侧皮动脉;起自腘动脉外侧壁,在排骨头平面上方(5.0±1.5)cm处浅出,外径为(0.9±0.3)mm,穿出前长度为(3.11.2)cm,伴腓肠外侧皮神经及其主要分支下行;②肌间隔筋膜皮支:起自胫后动脉(占54.5%)和腓动脉(占45.5%),向后外行,自小腿三头肌与腓骨长、短肌之间的肌间隔穿出,穿出点分别在腓骨头平面下方(9.2±3.8)cm和(15.8±3.8)cm,外径为(0.7±0.3)mm和(0.9±0.4)mm,穿出前长度分别为(3.6±1.1)cm和(3.6±1.4)cm.该营养动脉除在腓肠外侧皮神经主干及其分支旁或其内呈相互吻合,形成纵行的动脉丛(网)外,沿途还发出分支至周围的筋膜皮肤,并借吻合支     

腓肠神经-小隐静脉营养血管远端蒂复合瓣的解剖学研究

目的:为腓肠神经-小隐静脉营养血管远端蒂复合瓣设计提出解剖学依据.方法:30侧经动脉灌注红色乳胶成人下肢标本,解剖观测腓动脉肌间隔穿支、腓肠外侧动脉肌皮穿支与腓肠神经-小隐静脉、腓肠肌外侧头、比目鱼肌以及腓骨营养血管的关系;小隐静脉浅深交通支.结果:腓动脉肌间隔穿支6～10支,外径0.5～1.6 mm,最远的动脉穿支距外踝尖上(1.0±1.3)cm,外径(0.6±0.2)mm.穿支分出骨膜动脉、肌支,营养腓骨和比目鱼肌外侧半.穿支穿深筋膜时,发深筋膜支、皮支、皮神经浅静脉血管,构成腓肠神经-小隐静脉营养血管链.腓肠外侧动脉发2～5支外径0.2～1.2 mm肌皮穿支,营养腓肠肌外侧头及相应区域皮肤.小隐静脉浅深交通支距外踝尖上(3.4±0.9)cm,外径(1.7±0.5)mm.结论:腓肠神经-小隐静脉营养血管与肌、骨、皮营养血管同源,以腓动脉的肌间隔动脉终末穿支远端蒂复合瓣,旋转点近外踝尖平面,可覆盖前足创面.     

小腿在神经营养血管皮瓣的应用解剖

<正> 为小腿皮神经及其营养血管为蒂的岛状皮瓣提供解剖学基础.在8侧新鲜成人下肢,经动脉灌注红色乳胶后,解剖观测隐神经、腓浅神经及腓肠神经血供及其筋膜皮支的分布范围;2侧成人新鲜下肢标本经墨汁灌注、皮肤脱水透明后观测各皮神经的营养血管的分支、分布及吻合.结果显示:①隐神经有1～3支营养动脉,以隐动脉最恒定,其外径为(1.03±0.36)mm,沿途发出5～11个皮支达小腿内侧面的下部;②腓浅神经由腓浅动脉伴行,动脉外径为(1.0±0.04)mm,在小腿外侧的下1/3段发出筋膜皮支4～7支,最远可达神经前方5.8cm;③腓肠神经有营养动脉2～4支,动脉外径为(0.8±0.3)mm,筋膜皮支分布达小腿后面下部.小腿皮神经营养血管皮瓣设计容易,血供可靠,顺行转位可修复膝     

股前外侧逆行岛状皮瓣供血动脉层次关系及其临床意义

目的：为股前外侧带感觉神经逆行岛皮瓣的设计提供动脉层次关系的解剖学基础。方法：在54例下肢标本上解剖观察了旋股外侧动脉降支末端与膝周围动脉吻合的层次主股外侧皮神经的血供来源。结果：（1）在浅筋膜层内，股外侧皮神经的血供来源是多源性，分节段的，这些营养血管互相吻合成网过皮下组织达皮肤。（2）旋股外侧动脉降支末端在膝关节上方的深筋膜层与膝周围动脉的吻合有三个类型。结论：以股外侧皮神经及其营养或旋股外侧动脉降支为蒂截取股前外侧带感觉神经逆行岛状皮瓣可用于膝周软组织缺损或膝下截肢创面的修复。     

股部皮神经营养血管皮瓣的应用解剖

目的：为股部皮神经及其营养血管为蒂的岛状皮瓣提供解剖学基础。方法：８侧经动脉灌注红色乳胶成人新鲜下肢标本，解剖观测股部主要皮神经血供及其筋膜皮支的分布范围；２侧成人新鲜下肢标本经墨汁灌注，皮肤脱水透明后观测各皮神经营养血管的分支分布及吻合。结果：①股外侧皮神经有营养动脉２～６支，超始外径１．０±０．４ｍｍ，其筋膜皮支分布达神经内侧４．１ｃｍ，外侧５．９ｃｍ；②股前皮神经有营养动脉１～５支，外径１．０±０．３ｍｍ，其筋膜皮支分布达神经内侧２．４ｃｍ，外侧３．４ｃｍ；③股后皮神经有营养动脉１～３支，外径０．９±０．３ｍｍ，其筋膜皮支分布达神经内侧３．９ｃｍ，外侧３．２ｃｍ。结论：以股部各主要皮神经及其营养血管为蒂可沿其皮神经走行设计切取顺行或逆行岛状皮瓣     

远端蒂腓肠神经营养血管肌皮瓣的血供研究

目的　研究腓肠神经营养血管链与肌皮瓣血供之间的关系。 方法　17例新鲜成人小腿标本,16例灌注红色乳胶,1例灌注明胶氧化铅。解剖观测小腿后区各层中血管的解剖特点,重点观察腓肠神经营养血管链与肌皮动脉穿支之间的交通吻合。 结果　（1）外踝尖上10 cm内,后外侧肌间隔内腓动脉发出0~3支穿支,外踝后间隙内腓动脉终末支及其延续的跟外侧动脉,共发出2~3条皮肤穿支;（2）腓肠神经营养血管链在深筋膜下与两侧的腓肠肌肌皮动脉穿支间有2~7个吻合支,在深筋膜上与两侧的腓肠肌肌皮动脉穿支间各有2~3个吻合支。在腓肠肌的腱腹交界近侧2~4 cm内,与1~3支肌皮动脉穿支血管恒定交通吻合。 结论　（1）腓肠神经营养血管轴与腓肠肌内、外侧头肌皮动脉穿支之间有恒定的交通吻合,是远端蒂腓肠神营养血管肌皮瓣血供的基础;（2）在没有较粗的血管穿支的个体可将蒂部相邻的两个穿支包含在蒂内。     

股前及股外侧区皮神经营养血管皮瓣的应用解剖

目的：为股前及股外侧区皮神经营养血管皮瓣提供解剖学基础。方法：对20侧成人下肢标本铅丹乳胶液动脉灌注，运用各种方法观察股前及股外侧区皮神经营养血管的分支分布，分析以皮神经及其营养血管为蒂形成感觉皮瓣的可行性。结果：股外侧皮神经，股中间皮神经，股内侧皮神经解剖恒定，有内外两套血管系统，与皮下诸层次血管网互相沟通，构成股部皮神经营养血管皮瓣的解剖学基础。结论：股前及股外侧区皮神经营养血管皮瓣血供可靠，可设计不同形式的岛状皮瓣对会阴部组织器官缺损进行感觉性修复重建。     

足背外侧皮神经营养血管皮瓣的应用解剖学

目的:为足背外侧皮神经营养血管皮瓣设计提供解剖学依据。方法:32侧乳胶灌注的成人下肢标本,对足背外侧皮神经及其营养血管进行解剖,观察其起始、直径、走行、分支及分布情况。结果:足背外侧皮神经于外踝后方续于腓肠神经,起始处直径(2.65±0.57)mm,主干于外踝前下方(1.5±0.9)cm处发出分1～2条分支。足背外侧皮神经营养血管平均每侧4.8支,最为恒定的分支穿深筋膜时分别位于外踝后方平外踝最凸点,直径(0.75±0.16)mm;第5跖趾关节外侧近端(1.5±0.3)cm,直径(0.47±0.07)mm。结论:足背外侧皮神经营养血管皮瓣血供可靠,可以用来修复足前端或足底外侧创面。     

Formation and distribution of the sural nerve based on nerve fascicle and nerve fiber analyses

The formation and distribution of the sural nerve are presented on the basis of an investigation of 31 legs of Japanese cadavers using nerve fascicle and fiber analyses. Nerve fibers constituting the medial sural cutaneous nerve were designated as 'T', whereas those constituting the peroneal communicating branch were designated as 'F'. In 74.2% of cases (23/31), the T and F fibers joined each other in the leg, whereas in 9.7% of cases (3/31) they descended separately. In 16.1% of cases (5/31), the sural nerve was formed of only the T fibers. The sural nerve gave off lateral calcaneal branches and medial and lateral branches at the ankle. The lateral calcaneal branches always contained T fibers. The medial branches consisted of only T fibers, whereas most of the lateral branches consisted of only F fibers (71.0%; 22/31). In addition to the T and F fibers, P fibers, which derived from the superficial and deep peroneal nerves, formed the dorsal digital nerves. The P fibers were entirely supplied to the medial four and one-half toes. However, they were gradually replaced by the T and F fibers in the lateral direction. The 10th proper dorsal digital nerve consisted of T fibers only (38.7%; 12/31), of F fibers only (19.4%; 6/31) or of both T and F fibers (38.7%; 12/31). These findings suggest that the T fibers are essential nerve components for the skin and deep structures of the ankle and heel rather than the skin of the lateral side of the fifth toe. The designation of the medial sural cutaneous nerve should be avoided and only the T fibers are appropriate components for naming as the sural nerve.     

Dual sensory innervation of the dorsum of the thumb

The value of the thumb has been described as being almost equal to the rest of the fingers combined (Decker and du Plessis, eds. 1986, Lee McGregor's synopsis of surgical anatomy. 12th ed. p 496). Normal hand function is dependent upon the integrity of both the sensory and motor innervation of the thumb. A thorough knowledge of normal and anomalous sensory innervation of the digits has clinical application because of the increased use of local anesthesia and developments in plastic surgery involving the skin of the digits. Herein is reported an unusual variation in the sensory innervation of the thumb in an adult cadaver. The normal innervation of the dorsum of the thumb is reviewed, and the clinical importance of this variation is discussed.     

Examination of the variations of lateral femoral cutaneous nerves: report of two cases

The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.     

Injury to the lateral cutaneous nerve of forearm after venous cannulation: a case report and literature review

Venepuncture may be associated with nerve injuries and is commonly performed at the median cubital vein (MCV). Injuries to the superficial radial nerve at the wrist and to the median nerve, anterior and posterior interosseus nerves and medial and lateral cutaneous nerves (LCN) of the forearm at the cubital fossa have been reported. The LCN is a sensory branch of the musculocutaneous nerve and the position of the nerve in relation to the MCV is variable within the cubital fossa. The LCN supplies sensory innervation to the C6 dermatome corresponding to an area of skin overlying the radial border of the forearm. We report the case of a 30-year-old right-handed woman who presented with loss of sensation in the left forearm after donating blood at a transfusion centre. This was due to an injury of the LCN. After 3, 18 and 36 months of follow-up, the sensory deficit had only improved minimally. The lack of recovery of the sensation after 36 months indicates a permanent nerve injury such as neurotmesis rather than neurapraxia of the LCN. A thorough knowledge of the clinical anatomy of the MCV and the LCN, which is highlighted, is essential in preventing venepuncture-associated nerve injury.     

Anatomy of the lateral antebrachial cutaneous nerve in relation to the lateral epicondyle and cephalic vein

The lateral antebrachial cutaneous nerve (LACN) is the terminal sensory branch of the musculocutaneous nerve supplying the lateral aspect of forearm. Because of its close proximity to the biceps brachii tendon (BBT), the lateral epicondyle (LE), and the cephalic vein (CV), surgery and venipuncture in the cubital fossa can injure the LACN. Measurement data regarding the relative anatomy of LACN are scarce. We, therefore, dissected 96 upper extremities from 26 males and 22 females to expose the LACN in the cubital fossa and forearm. The LACN consistently emerged from the lateral margin of BBT. It then pierced the deep fascia distal to the interepicondylar line (IEL) in 84.4% with mean distances of 1.8 ± 1.1 and 1.2 ± 0.9 cm (male and female, respectively). At the level of IEL, the LACN in all cases was medial to the LE (5.9 ± 1.1 cm male and 5.2 ± 0.9 cm female). Two types of branching were observed: single trunk (78.1%) and bifurcation (21.9%). Asymmetry in the branching pattern was observed in 6 males and 1 female. Concerning the relationship to the CV, the LACN ran medially within 1 cm at the level of IEL in 78.7%. Moreover, in 10 specimens, the LACN was directly beneath the CV. In the forearm, the LACN tends to course medial to the CV. Significant differences in the measurement data between genders but not sides were found in some parameters. These data are important for avoiding LACN injury and locating the LACN during relevant medical procedures.     

带臂外侧上皮神经及其营养血管筋膜皮瓣的应用解剖

目的:为带臂外侧上皮神经及其营养血管筋膜皮瓣提供解剖学基础.方法:32例经灌注红色乳胶的成人上肢标本,对臂外侧上皮神经及其营养血管等进行了较详细的应用解剖学研究.结果:臂外侧上皮神经在均由腑神经发出,起点横径为1.5±0.4mm,在三角肌深方斜向外下3.6±1.1cm从该肌后缘中1/3浅出肌间隔,分为上支和下支,分布于三角肌后部、外侧部和臂外侧上部.该神经的营养血管起源于旋肱后动脉,起点外径为0.9±0.4mm;其行程、分支和分布均同在神经,供血范因为14.8×9.8cm~2,并与周围的皮动脉存在丰富吻合.结论:带臂外侧上皮神经及其营养血管筋膜皮 瓣可视受区需要设计成游离瓣或旋转瓣,用于修复邻近部位、手或颌面部缺损.     

头静脉动脉化前臂外侧皮神经移植的解剖学基础及应用

在30侧成人固定上肢上,对头静脉蒂前臂外侧皮神经游离移植进行了有关解剖学观察.前臂外侧皮神经主干在肘横纹处横径为2.2mm,70％在头静脉深面;在前臂中部横径为1.4mm,23％在头静脉深面,77％在头静脉尺侧,距头静脉0.6cm.1987年9月以来,采用头静脉蒂动脉化前臂外侧皮神经游离移植,修复腕部正中、尺神经陈旧性损伤3例,疗效较满意.     

臂下外侧皮神经痛诊治的解剖学基础

目的 介绍臂下外侧皮神经痛的诊断与局部注射的治疗方法。方法 选择门诊确诊为臂下外侧皮神经痛的患者5例，采取强的松龙混悬液加局部麻药的局部注射神经通过上臂外侧肌间隔及深筋膜处的方法。结果 所有病情皆在注射后短时间完全止痛，一周后痊愈。结论 对诊断明确的病例，采用强的松龙局部注射法，可以获得满意的疗效。