拇指尺背侧皮瓣的解剖和临床应用

目的;介绍一种修复指端创面的新皮瓣。方法：解剖并观察20只成人新鲜尸体手拇指掌指关节尺背侧区的动脉来源,行径和分布范围,并临床应用修复拇指指端创面10例,示指指端创面2例。结果：拇指尺侧背动脉自第一背侧骨间肌处穿出,外径为0.3-0.9mm,出现率为90％,分布于第一掌指关节尺侧和拇指尺背侧,在皮下组织内沿拇长伸肌腱向远侧走行,在指掌弓和指背动脉弓形成吻合。临床应用12例皮瓣无水泡,紫绀及坏死,均一期愈合,随访3－10个月,外形满意。结论：该皮瓣血管解剖恒定,部位隐蔽,手术操作简单,损伤小,不失为指端特别是拇指创面修复的较好方法之一。     

拇指尺背侧动脉为蒂的逆行皮瓣

目的介绍以拇指尺背侧动脉为蒂逆行皮瓣的手术方法和适应证.方法对5例拇指远端软组织缺损并伴骨外露者,采用以拇指尺背侧动脉为蒂的皮瓣逆行转移修复.该皮瓣的设计以拇指尺背侧动脉体表投影线为轴心线,距甲沟2.3 cm处纵轴线向背侧动脉穿支为旋转点,皮瓣面积可达3.0 cm × 2.5 cm.结果术后5例皮瓣全部成活.术后随访2 ～ 6个月,拇指外形满意,指腹二点分辨觉为6 ～10 mm. 指间关节活动范围从0°～70°左右.结论该术式的最佳适应证为拇指远端皮肤缺损并伴骨外露者.     

拇指尺背侧岛状皮瓣修复拇指深度创面的临床应用

目的 了解拇指尺背侧岛状皮瓣修复拇指深度创面的效果 . 方法 2007年5 月-201 3年12月,笔者单位应用拇指尺背侧岛状皮瓣共修复22例患者拇指Ⅳ度损伤创面,创面面积为2.0cm×1.5cm～4.0cm×2.5cm,皮瓣切取面积为2.1cm×1.6cm～4.1cm×2.6cm,供瓣区均于同侧上臂内侧切取全厚皮片移植修复 . 结果 术后皮瓣全部成活,血运良好,拇指创面愈合良好,供瓣区移植皮片成活 . 术后随访6个月～1年,患者皮瓣质地、色泽、外形良好,患指功能恢复良好.结论 拇指尺背侧岛状皮瓣具有手术操作简单、术后成活率高、外形不臃肿等优点,是修复拇指深度创面的较佳选择.     

拇指尺背侧动脉的超声探测

目的应用超声检查探测右拇指尺背侧动脉的出现率和走行情况，为术前皮瓣选择提供参考依据。方法应用超声检查对62例健康成人右拇指尺背侧动脉和指固有动脉进行探测。其中，应用二维和彩色多普勒成像方法显示其位置和血流的宽度并进行测量，应用频谱多普勒成像法进行动脉性验证。结果62例中，右拇指尺背侧动脉未探及8例(8／62，占13％)，探及54例(54／62，占87％)，探及者中有2～3条动脉者为3例(3／54，占5％)。指固有动脉探及率为100％。结论超声检查能很好的完成拇指尺背侧动脉(小动脉)的探测，为术前以该动脉为血管蒂皮瓣的选择提供简单、有效的检测手段。     

足背皮神经营养血管皮瓣的临床应用与解剖学研究

目的评估足背皮神经营养血管皮瓣的疗效。方法成人下肢标本32侧,解剖观测足背皮神经及其营养血管分布,设计皮瓣。临床应用逆行足背皮神经营养血管皮瓣修复足背软组织缺损30例。结果可单独设计足背内侧、中间和外侧皮神经的顺行或逆行皮神经营养血管皮瓣,腓深神经终末支皮神经营养血管皮瓣可以和足背内侧皮神经营养血管皮瓣联合使用。临床皮瓣的切取面积为（3．5～5．5）cm×（2．0～9．0）cm。27例愈合顺利,3例经按摩后完全存活。平均随访2．3年。外观满意,穿鞋无碍。结论逆行足背皮神经营养血管皮瓣修复足背中、小面积软组织缺损疗较满意,简便有效。     

逆行肱桡肌皮瓣的解剖与临床应用

目的介绍逆行肱桡肌肌皮瓣修复前臂远端及腕部软组织缺损的手术方法。方法通过对2 0侧新鲜成人尸体上肢标本的应用解剖学研究,观测到肱桡肌有三组供血系统,由近及远分别为桡侧副动脉、桡侧返动脉及桡动脉发出的肌支,各营养血管又在肌内形成丰富的吻合。设计以桡动脉发出肱桡肌肌支为蒂的逆行肱桡肌肌皮瓣;临床应用8例修复前臂远端或腕部软组织缺损,皮瓣面积为15cm×8cm～8cm×6cm。结果8例肌皮瓣全部成活,皮瓣外形、质地满意。供区肘关节功能正常。结论以桡动脉肌支为蒂设计的逆行肱桡肌皮瓣,对修复前臂远端或腕部软组织缺损是一种较为简便易行的手术方法。     

Irreducible dorsoulnar dislocation of the proximal phalanx of the thumb

A case of irreducible complete dorsoulnar dislocation of the proximal phalanx of the thumb is presented. The pathologic anatomy included intersubstance tears of the ulnar collateral ligament and dorsal capsule and avulsions of the palmar plate and radial collateral ligament from their metacarpal attachments. The palmar plate blocked reduction, as did the radial collateral ligament that was caught on the margin of a tear in the adductor aponeurosis and on the tendon of the extensor pollicis longus. A review of the English-language literature indicates that this pathologic anatomy has not been described.     

The anconeus muscle flap: its anatomy and clinical application

The arterial anatomy, coverage area, and potential donor site morbidity of the anconeus muscle flap are described. Using 17 cadaveric upper extremities, we investigated the muscle's arterial anatomy in 12 specimens and defined the coverage area of the anconeus flap in 5 specimens. We also reviewed the records of 9 patients who underwent a pedicle anconeus muscle flap for elbow coverage to assess clinical results of the procedure. The anconeus muscle is supplied from 3 arterial pedicles: the recurrent posterior interosseus artery, the medial collateral artery, and the posterior branch of the radial collateral artery. The recurrent posterior interosseus artery and the medial collateral artery were present in all dissected cadavers and consistently anastomosed with each other underneath the anconeus muscle. By harvesting the muscle on the medial collateral artery, the anconeus muscle flap can be expected to cover a 7.3 cm2 defect over the radiocapitellar joint, a 6.1 cm2 defect over the distal triceps tendon, and a 7.2 cm2 defect over the olecranon. In this series, none of the patients experienced loss of elbow motion, stability, or extension strength. The results of this study indicate that the anconeus can be harvested with minimal risk of morbidity and provides effective coverage for soft tissue defects of the elbow.     

Venous anatomy of the thumb.

The venous anatomy of 20 thumbs (10 pairs) was detailed by latex injection. The thumbs were studied on the dorsal, palmar, radial, and ulnar surfaces. Characteristic patterns were found; these included a dominant longitudinal network, palmar veins within the pulp, oblique veins at the interphalangeal joint on the radial side, and a web space vein. A layered vascular pattern with a superficial fine network overlying a deeper system was noted. Cross sections were taken at the metacarpophalangeal joint and at the proximal and distal phalanges. The distribution of the vessels in cross section reveals consistent dorsal veins at all levels, as well as palmar veins distal to the interphalangeal joint in all thumbs. Palmar veins were present over the length of the proximal phalanx in more than 65% of the thumbs.     

外踝上穿支皮瓣解剖分析与临床应用

目的：探讨改进外踝上穿支皮瓣的手术方法及临床效果。方法在解剖观测基础上设计以外踝上穿支升支为血管蒂,结扎其降支,在小腿外侧以腓动脉皮支穿出点连线为皮瓣轴线设计切取皮瓣,转位修复小腿中下段及足踝部皮肤软组织缺损。结果本组14例皮瓣全部成活,皮瓣面积7 cm＆#215;12 cm～16 cm＆#215;23 cm,穿支血管蒂长1.6～2.8 cm。术后随访6～18个月,皮瓣肤色与周围相近,略臃肿,外观较为满意,创区功能恢复好。结论解剖研究为临床外踝上穿支皮瓣手术提供解剖学依据,经改进的外踝上穿支皮瓣为足踝部大面积皮肤缺损的修复提供了一种实用性新方法。     

第Ⅱ掌背动脉岛状皮瓣的显微解剖及临床应用

通过30只成人尸体手第二掌背动脉的解剖学观测,发现该动脉是一条起源于桡动脉腕背支的典型的干型血管,以其为营养血管可形成轴型皮瓣。该皮辦可顺行、可逆行,可形成类似于食指背皮辦的中指背皮瓣.临床已应用7例,6例为电烧伤,1例为热压伤。3例为顺行皮瓣,4例为逆行皮瓣,除1例中指背皮瓣远端尺侧少许发生坏死外,余均成活良好。我们对该动脉的起源问题,供血范围及手术注意事项等进行了讨论。     

第Ⅱ掌背动脉岛状皮瓣的显微解剖及临床应用

通过３０只成人尸体手第二掌背动脉的解剖学观测，发现该动脉是一条起源于桡动脉腕背支的典型的干型血管，以其为营养血管可形成轴型皮瓣。该皮瓣可顺行、可逆行，可形成类似于食指背皮瓣的中指背皮瓣。临床已应用７例，６例为电烧伤，１例为热压伤。３例为顺行皮瓣，４例为逆行皮瓣，除１例中指背皮瓣远端尺侧少许发生坏死外，余均成活良好。我们对该动脉的起源问题，供血范围及手术注意事项等进行了讨论。     

Functional anatomy and biomechanics of the thumb.

The thumb is a mechanical unit consisting of strong ligaments and dynamic muscles, providing the resistance to the fingers and palm during pinch and grip. Each thumb joint has a mechanical equivalent that helps explain elements of thumb stability. The trapeziometacarpal joint is potentially the most unstable but has adapted to its unique position by special joint geometry and, in particular, a combination of support ligaments that permit a wide range of motion yet stability. New anatomic and mechanical studies demonstrate the key support structures that must be duplicated by reconstructive surgical procedures if thumb stability is to be maintained.     

小腿穿支血管筋膜蒂皮瓣的解剖研究与临床应用

目的 通过研究小腿不同区域皮肤穿支血管的分布特点及规律,探讨小腿穿支血管筋膜蒂皮瓣在下肢创伤性软组织缺损修复中的临床应用价值.方法 选取38侧下肢标本,其中12侧用于全程追踪各穿支血管的来源与分布;另26侧用于观察并测量外径≥0.5 mm穿支血管的穿出部位、走行方向、分支、分布及吻合情况等.1998年5月至2010年11月临床应用多普勒血管测听仪测听穿支血管,并根据小腿穿支血管走行轴线设计带穿支血管的筋膜蒂皮瓣,邻近转位修复62例下肢皮肤软组织缺损创面患者,男50例,女12例;年龄7～78岁,平均40岁.创面部位:胫骨上段10例,胫骨中下段32例,足踝部20例.缺损面积为2cm×3cm～9cm×l6cm.结果 解剖发现小腿内侧、后侧、后外侧及前外侧有4条明显的营养血管链,其中内侧隐神经与后侧腓肠神经走行区营养血管链的穿支最多.本组59例患者术后皮瓣完全成活,2例逆行皮瓣远端表皮坏死结痂,1例皮瓣远端部分皮肤坏死行二期植皮.62例患者术后获3～48个月(平均8个月)随访.皮瓣外观与质地满意,无一例患者发生骨髓炎.结论 在小腿4条链状血管丛走行区,以纵向走行的穿支血管为纵轴线切取离创面最近的筋膜蒂皮瓣,其切取方法简便、对穿支血管干扰小、血供可靠,为下肢创伤性软组织缺损提供了一种安全、有效的修复方法.     

Venous anatomy of the thumb and thenar area.

The venous anatomy of the thumb and the thenar area, including the first web space, was studied after injection of a polymerizing plastic resin into the vascular tree of six fresh human cadaveric specimens. As in the previously described parts of the hand and fingers, certain anatomical features were consistently present in all examined specimens. The topography of the vessels is different from that of veins in other parts of the hand, and we conclude that this reflects differences in mechanical demands upon the soft tissues in various parts of the hand and the digits.     

尺动脉腕背降支为蒂的岛状皮瓣的临床应用

目的总结尺动脉腕背降支为蒂的岛状皮瓣移植修复手背软组织缺损的临床应用。方法应用这种方法修复6例手部软组织缺损,右手4例,左手2例;年龄:16～46岁(平均30岁),缺损范围:3cm×3cm～4cm×7cm,切取尺背侧岛状皮瓣范围:最大5cm×8cm,最小3.5cm×4cm。供区2例直接缝合,4例行中厚网状游离植皮。结果1例术后供区发生远端尖部小片植皮坏死,经2周交换敷料逐渐自行愈合,所有皮瓣全部成活,取得了满意的临床效果。结论该岛状皮瓣以尺动脉腕背降支为血供,血运丰富、血管解剖恒定以及血管蒂长,适宜修复手部软组织缺损。     

内眦动脉为蒂的角形穿支皮瓣的解剖基础与临床应用

目的 探讨应用内眦动脉角形穿支皮瓣修复中面部缺损的解剖学基础及临床应用效果.方法 ①对10具新鲜成人尸体行一次性动脉造影及螺旋CT扫描,数据以DICOM格式输入MIMICS图像工作站,进行三维可视化处理,观测内眦动脉穿支血管的分布规律等.②2012年7月至2014年7月,应用内眦动脉为蒂的角形穿支皮瓣修复中面部皮肤缺损创面21例,其中鳞状细胞癌10例,基底细胞癌9例,色素痣2例,切取的皮瓣面积1.5 cm×3.5 cm～2.5 cm×5.0 cm.结果 面动脉在口角外侧约1 cm处发出侧鼻动脉,后向内眦延续为内眦动脉,角动脉与鼻背动脉、眶下动脉有丰富的吻合支.临床应用内眦动脉为蒂的角形穿支皮瓣修复21例缺损均成活,供、受区创面愈合良好,经1个月至2年随访,色泽、质地、外形恢复较好.结论 内眦动脉角形穿支皮瓣,设计灵活、简便,血供可靠,切口隐蔽,供区可直接拉拢缝合,是修复中面部缺损的一种较好的方法.     

Preliminary report: the distally pedicled dorsoulnar forearm flap for hand reconstruction.

In this paper, a new flap for the coverage of soft tissue defects in the hand is described. To obtain a distally pedicled dorsoulnar flap, the dissection of the standard dorsoulnar flap is continued distally under the descending branch of the dorsal branch of the ulnar artery onto the dorsum of the wrist after the dorsal branch of the ulnar artery is ligated and divided. Our modification of the standard dorsoulnar flap converts this flap to a distally based flap, which provides a potentially longer pedicle and increases the arc of rotation of the flap. Two successful cases are reported.     

Arterial anatomy of the lower lip.

The arterial anatomy of the lower lip was investigated in 12 sides of six fresh cadavers that had been injected systemically with a lead oxide and gelatin mixture. We found that the blood supply of the lower lip was derived from the facial artery and three dominant labial arteries: the inferior labial artery, the horizontal labiomental artery, and the vertical labiomental artery. The inferior labial artery was derived from the facial artery or superior labial artery, and ran through the submucous tissue horizontally. The horizontal labiomental artery arising from the facial artery was located between the depressor labii inferioris muscle and orbicularis oris muscle. The vertical labiomental artery arose from the submental artery. These three arteries provided small vessels that traversed vertically. These small vessels and the small branches of the facial artery, that run superficial and deep to the orbicularis oris muscle, formed a vascular network in subcutaneous and submucous tissues and minute vessels branched off to the skin, mucosa, and muscles.     

岛状鼻侧软骨粘膜瓣的解剖学研究及临床应用

目的：研究进入鼻侧软骨区域的主要血管,为设计内眦血管蒂岛状鼻侧软骨粘膜瓣修复眼睑衬里和睑板缺损提供解剖学基础,并介绍其临床应用经历。方法：10具存放一年的成年尸体标本从颈总动脉灌注红色乳胶,在2具尸体标本的面静脉内注入蓝色乳胶溶液。在3．5倍的手术放大镜下进行解剖,显露鼻背和鼻周区的血管。结果：内眦动脉发出分支从鼻侧软骨的外上方开始斜向其内下方向走行进入鼻侧软骨的表面,并与鼻背动脉和鼻外侧动脉向鼻侧软骨表面发出的分支相互吻合。并且内眦静脉与其伴行。应用岛状鼻侧软骨粘膜瓣修复下睑缺损1例,效果满意。结论：以内眦血管为蒂的岛状鼻侧软骨粘膜瓣具有良好的血液供应,血管蒂长并且走行比较恒定,可转移到眶区修复部分眼睑衬里和睑板缺损。