带腓肠神经及其营养血管筋膜皮瓣的应用解剖

目的　为带腓肠神经及其营养血管筋膜皮瓣的应用提供解剖学基础。　方法　在３２ 侧成人下肢标本上进 行解剖， 对腓肠神经及其 营养血管进行详细观 测。　结果　 吻合型腓 肠神经占５３１ ％ ；非吻合型占４６９ ％ 。该神经的营养血管为腓肠浅动脉和穿动脉， 腓肠浅动脉于腓骨头上方（５０ ±１５）ｃ ｍ 由腘动脉发出，起始处外径为（０８ ±０３ ） ｍ ｍ ，伴腓肠内侧皮神经和腓肠神经下行， 与踝关节附近的皮动脉进行吻合；穿动脉则来源于胫后动脉肌皮支和腓动脉肌间隔皮支， 其外径分别为（０８ ±０４） ｍ ｍ 和（０８ ±０３） ｍ ｍ 。这些皮动脉除与腓肠浅动脉构成链式吻合外，并借分支与筋膜皮支形成广泛的筋膜皮血管网。　结论　可以腓肠神经及其营养动脉为蒂设计筋膜皮瓣，转位修复小腿中下部、踝关节周围等软组织缺损     

带肋间神经外侧前支脐旁感觉皮瓣的应用解剖

目的为形成带感觉神经的脐旁游离皮瓣提供解剖学基础。方法在２０具４０侧成人躯干标本上,观测了下位肋间神经外侧前支与腹壁下血管形态、分支及分布规律。结果腹壁下动脉起点外径为（２．３±０．３）ｍｍ,伴行静脉（３．６±０．４）ｍｍ。下位肋间神经外侧前支在腋前线前后１～２ｃｍ相应肋间穿出,神经在锁骨中线附近浅出皮下。第８～１０肋间神经外侧前支浅出皮下在脐上０～７ｃｍ范围内,恰好支配脐旁皮瓣设计的范围。结论可设计以腹壁下血管带第８～１０肋间神经外侧前支的脐旁感觉皮瓣。     

骨间后动脉桡侧支的显微解剖及其临床意义

目的研究骨间后动脉桡侧支的应用解剖及其临床意义。方法观察２３具４６侧成人上肢标本的骨间后动脉桡侧支。结果骨间后动脉桡侧支在桡骨小头上缘平面以下６９．４±７．３ｍｍ（ｘ±ｓｘ，下同）发自骨间后动脉，其出现率为８０．４％（３７／４６侧）。该动脉恒定地在指伸肌与桡侧腕长伸肌的肌间隙穿出深筋膜，穿出点在肱骨外上髁与Ｌｉｓｔｅｒ结节连线的中点。血管蒂长度为４５．１±６．８ｍｍ；动脉起始点外径为０．８±０．２ｍｍ，穿出筋膜点时外径为０．４±０．１ｍｍ。１９．６％的标本骨间后动脉桡侧支缺如，由发自桡侧返动脉降支的肌皮支代偿，支配相应区域的软组织。结论骨间后动脉桡侧支为肌间隙血管，临床上可在前臂以此血管设计成相应的组织瓣（皮瓣、骨瓣或骨膜瓣），修复上肢皮肤缺损。     

桡动脉腕上皮支前臂外侧逆行皮瓣的应用解剖

目的　为桡动脉腕上皮支前臂外侧岛状皮瓣的设计提供解剖学依据。　方法　 3 0侧经动脉灌注红色乳胶成人上肢标本 ,解剖观测桡动脉腕上皮支的起源、分支分布及其邻近动脉吻合。　结果　桡动脉腕上皮支于桡骨茎突上 (4 .2± 1.3 )cm始于桡动脉桡侧 ,干长 (0 .8± 0 .5 )cm ,外径 (0 .8± 0 .2 )mm。分出数支外径在 0 .3～ 5 .0mm皮支分布前臂远段桡侧面 ,腕上皮支与桡骨茎突返支、鼻烟壶皮支吻合 ,并构成头静脉、桡神经浅支和前臂外侧皮神经前支的营养血管。　结论　以桡动脉腕上皮支为蒂的前臂外侧岛状皮瓣 ,可移位修复手背组织缺损。     

前臂外侧皮神经的血供特点与皮神经营养血管皮瓣的设计

目的：为临床设计带外侧皮神经营养血管筋膜皮瓣提供依据。方法：用显微解剖测量法、标本透明法研究前臂外侧皮神经外科解剖与头静脉的关系及其神经血管皮肤穿支的位置、长度、对皮神经的营养形式等。结果：前臂外侧皮神经共有４支神经血管皮肤穿点，其全程由神经旁血管和主要动脉共同营养。前臂外侧皮神经前支与头静脉紧密伴行。结论：顺沿头静脉，可切聚带外侧皮神经营养血管筋蒂或血管神经蒂岛状皮瓣，用于修复肘部、前臂远端１／     

锁骨上皮瓣的应用解剖

锁骨上皮瓣是修复面颈部缺损的较理想供区。在３０例成人标本上，对锁骨上皮瓣血管进行了巨微解剖观测。该皮瓣的血供主要是颈横动脉或其浅支发出颈皮支（共８３．３％），少数来自肩胛上动脉或其浅支发出的颈皮支，回流静脉主要是颈外静脉。皮瓣的血管蒂如带上起源动脉，则长４．０ｃｍ，外径２．２ｍｍ，皮支分布面积８ｃｍ×１０ｃｍ，可作为游离或带血管蒂皮瓣。此皮瓣还可带锁骨上中间神经作成游离感觉皮瓣。     

有血供的尺神经移植的解剖学研究

目的：对尺神经主干的血供进行解剖研究，以提供临床作吻合血管的尺神经移植时参考。方法：在２２侧成人尸体标本上观测尺神经外部血供情况。另用墨汁灌注一侧新鲜成人尸体上肢，对尺神经内部微血管结构，进行了观测分析。结果：臂部尺神经营养动脉平均为２．３支，走行度５．１ｍｍ，起始处外径０．５入神经处外径０．３ｍｍ。前臂部尺神经营养动脉平均为６．５支，走行长度７．０ｍｍ，起始处外径０．４ｍｍ，入神经处外径０．２ｍ     

前臂外侧皮神经的血供特点与皮神经营养血管皮瓣的设计

目的：为临床设计带外侧皮神经营养血管筋膜皮瓣提供依据。方法：用显微解剖测量法、标本透明法研究前臂外侧皮神经外科解剖与头静脉的关系以及其神经血管皮肤穿支的位置、长度、对皮神经的营养形式等。结果：前臂外侧皮神经共有４支神经血管皮肤穿支,其全程由神经旁血管和主要动脉共同营养。前臂外侧皮神经前支与头静脉紧密伴行。结论：顺沿头静脉,可切取带外侧皮神经营养血管筋膜蒂或血管神经蒂岛状皮瓣,用于修复肘部、前臂远端１／３段和腕部等部位软组织缺损。     

颈横血管肩胛冈支骨瓣移位修复下颌骨缺损的应用解剖

目的为下颌骨缺损提供带血管蒂骨瓣移位修复术的应用解剖学基础。方法在１５具（３０侧）灌注红色乳胶的成人尸体标本上,观测颈横血管及其肩胛冈支的走行、分支及分布。结果颈横动脉全程分为：颈段,长（４．７±０．１）ｃｍ,起始外径（４．０±０．１）ｍｍ;背段,长（５．８８±０．６３）ｃｍ,起始外径（３．３０±０．３５）ｍｍ。颈横动脉肩胛冈支８６．７％起于颈横动脉浅支,１３．３％起自颈横动脉,干长（４．９７±１．６８）ｃｍ,起始外径（２．０８±０．２７）ｍｍ。肩胛冈支恒定地向肩胛冈发出４～８支骨膜支营养肩胛冈。结论颈横血管肩胛冈支是肩胛冈区的主要血供来源之一,以其为蒂的肩胛冈骨瓣可以颈横血管背段起始处为旋转点向下颌区移位,血管蒂平均长约１０．８５ｃｍ,可为下颌骨缺损修复提供一种新的术式。     

手及前臂皮神经营养血管蒂皮瓣的应用解剖

目的：观察手及前臂皮神经营养血管的情况，为设计以皮神经及其营养血管为蒂的岛状皮瓣提供形态学依据。方法：用红色氯仿油画染料灌注的20侧成人上肢标本，在手术显微镜下解剖并观测手及前臂 5条皮神经营养血管的来源、数目、外径，穿出深筋膜的位置，与皮神经及浅静脉的关系等项目。结果；营养动脉多以降支方式伴行在皮神经深面内侧，前臂皮神经的血管网可达神经两侧各2．5cm范围内的皮肤，5条皮神经的营养动脉外径接近，结论：手及前臂皮神经的营养血管血供可靠，可设计相应部位的岛状皮瓣。     

Anatomic study of distally based pedicle compound flaps with nutrient vessels of the cutaneous nerves and superficial veins of the forearm

The purpose of this study was to describe the anatomic basis for a distally based neurovenovascular pedicle compound flap, with nutrient vessels of the cutaneous nerves and superficial veins of the forearm. In this study, the origins, branches, and anastomoses of nutrient vessels of the cutaneous nerves and superficial veins of the forearm and their relationships with the blood supply of adjacent muscle, bone, and skin were assessed in 96 adult cadavers by perfusion of red gelatin into the superior limb arteries. The results showed that the nutrient vessels of cutaneous nerves and superficial veins of the forearm were found to have multiple origins, consisting of six longitudinal vascular plexuses and one transverse vascular plexus of the forearm, as follows: 1) the anterior-lateral vascular plexus from cutaneous branches of the radial artery; 2) the anterior-medialis vascular plexus from cutaneous branches of the ulnar artery; 3) the dorso-lateral vascular plexus from radial osteal and cutaneous branches; 4) the dorso-medialis vascular plexus from ulnar osteal and cutaneous branches; 5) the radial vascular plexus from osteal and cutaneous branches of the radial artery, cutaneous branches of the radial artery in the upper wrist, recurrent branches of the styloid process of the radius, and the radialis vascular plexus of cutaneous branches of the tabatière anatomique (anatomical snuffbox); and 6) the ulnar lateral vascular plexus from cutaneous branches of the ulnar artery in the upper wrist and osteal and cutaneous branches. The transverse vascular plexus is composed of dorsal branches of the ulnar and radial arteries. These perforating branches give fascial branches, cutaneous branches, periosteal branches, and nutrient vessels of cutaneous nerves and superficial veins. These results suggest that nutrient vessels of the cutaneous nerves and superficial veins of the forearm have the same origins as those of the nutrient vessels of adjacent muscles, bones, and skin of the forearm, which can be designated as five types of distally based pedicle flaps with nutrient vessels of cutaneous nerves and superficial veins of the forearm, whose rotation point is at the wrist joint. This flap can be applied to repair tissues of distal parts of the hand.     

The radial forearm flap without fascia and other refinements

The radial forearm flap is generally classified as a fasciocutaneous flap. The skin of the forearm is, however, supplied by branches from the radial artery which pierce the fascia of the forearm to course and branch subcutaneously. We have used the flap as a skin flap in 300 cases over 11 years. It is not necessary to take the fascia with the flap. Two other refinements of the forearm flap, also used over the past 11 years, are described. The venous drainage of the flap is simplified by utilising the usual anatomical confluence of deep and superficial veins at the elbow. Secondly, draping a large loop of pedicle in the neck during intraoral reconstruction enables a larger calibre vein to be used for the anastomosis, thus increasing its reliability.     

腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的应用解剖

目的研究腓肠神经-小隐静脉营养血管远端蒂皮瓣动脉穿支的分布规律及临床应用。方法对30侧动脉灌注红色乳胶成人下肢标本,解剖观测远端蒂部的动脉来源及分布。2003年1月～2004年8月,在解剖学研究的基础上,临床采用低旋转点的腓肠神经-小隐静脉营养血管远端蒂皮瓣36例。其中男21例,女15例。年龄6～66岁,平均35.2岁。足跟及足底部皮肤缺损18例,足背部缺损10例,中前足缺损8例,均伴有骨、肌腱外露。缺损范围:3.5cm×2.5cm～17.0cm×11.0cm,切取皮瓣4cm×3cm～18cm×12cm。结果远端蒂动脉穿支2～5支,来源于跟外侧动脉穿支及外踝后动脉穿支,外径0.6±0.2mm和0.8±0.2mm,距外踝尖上1.0±1.3cm和2.8±1.0cm。腓动脉肌间隔穿支0～3支,出现率依次为96.7%、66.7%和20.0%,外径0.9±0.3、1.0±0.2和0.8±0.4mm,距外踝尖上5.3±2.1、6.8±2.8和7.0±4.0cm。动脉穿支发出皮支、皮神经浅静脉营养支和深筋膜支,形成腓肠神经-小隐静脉营养血管链和深、浅筋膜血管网。临床应用36例皮瓣全部成活,仅3例术后皮瓣边缘少量坏死,经换药后愈合。所有患者经8～16个月随访,供区外形良好,患肢能正常行走,皮瓣感觉逐步恢复。结论以外踝后动脉穿支为蒂,皮瓣旋转点在外踝尖上3.0cm。以跟外侧动脉穿支为蒂,皮瓣旋转点近外踝尖平面。     

Folded free radial forearm flap for reconstruction of full-thickness defects of the cheek

Background. Full thickness defects of the cheek have been conventionally reconstructed using the folded forehead flap, cervical flap, pectoralis major myocutaneous flap, or deltopectoral flap in various combinations. We report a modified technique of folding the radial forearm flap for reconstruction of full-thickness defects of the cheek. Methods. The free radial forearm flap is a type C fasciocutaneous flap based on the radial artery along with its vena commitans and superficial forearm vein. The size and shape of the flap are determined according to the dimensions of the surgical defect. The flap is then lifted off with the fascia of the forearm making it a fasciocutaneous flap, in which the radial artery lies deep to the fascia and gives numerous branches. The flap is disconnected from the donor site only after the recipient vessels have been prepared for anastomosis. Vascular anastomosis is then performed using the operating microscope. This technique was used in 13 patients with carcinoma of the buccal mucosa who underwent full-thickness excision of the cheek. Results. Flap edema was observed in 4 patients in the immediate post-operative period. Necrosis of the outer paddle was seen in 1 patient. Donor site morbidity was seen in 4 patients who required dressings on an outpatient basis for up to 3 weeks. Conclusion. Single-stage reconstruction of full-thickness defects of the cheek with the folded free radial forearm flap is reliable and produces excellent cosmesis with minimal donor site morbidity. © 1995 Jons Wiley & Sons, Inc.     

A new distally pedicled adipocutaneous perforator forearm flap]

A new distally pedicled adipocutaneous perforator forearm flap useful in corrections of congenital anomalies of hand was described. Due to the congenital anomaly expression the perforators may origin from radial, median, ulnar or anterior interosseous artery which supply blood flow into the flap tissues. Raising the flap from anterior and radial surface of the forearm begins from the proximal to the distal part, above the fascia leaving superficial cutaneous nerves and cephalic vein intact. The flap may be safely incised in the ratio 5:1 and the pivot point is localized in the place where perforators pierce the forearm fascia usually 1-2 cm above the rascetta. Rerouting of the flap distally on the hand makes reconstruction of missing thenar, the first web space or even finger tissues possible. These conditions are basal for further reconstruction in advanced hypoplasia of the radial part of hand. Similar flap may be used in the posttraumatic cases when the flap blood supply comes exclusively from radial artery perforators.     

Safety of carpal tunnel release with a short incision. A cadaver study

The standard long incision technique for carpal tunnel release causes inevitable damage to skin sensation, the inter-thenar plexus and especially the distal branches of the palmar cutaneous branch of the median nerve (PCM), and may cause long-term disabling pain and scar tenderness. There are many variations in the distal branches of the median nerve at the wrist. Anatomic studies of this region also have important clinical implications to prevent injury to important anatomic structures. The purpose of this study was to evaluate the short-incision carpal tunnel release in cadavers. Several important anatomic structures, with possible anatomic variations, pass through the carpal tunnel, and blind percutaneous transection of the transverse ligament seems to be a high risk procedure. Sixty hands from 40 fresh cadavers were evaluated. Both the transverse ligament and the distal third of the deep forearm fascia were released using a Smillie knife. At the end of each procedure, the hand was explored for injury to tendinous and neurovascular structures of the wrist. In all cases the release of the carpal tunnel and the distal third of the forearm fascia was found to be complete. The superficial palmar arterial arch, flexor tendons, ulnar nerve and vessels, digital nerves, median nerve and its recurrent accessory branches, the flexor tendons, and even the subcutaneous tissue over the transverse ligament were damaged in no instance. Guyon's canal was entered in 6 (10%) hands without damage to its components. The distal branches from the ulnar side of the palmar cutaneous branch of the median nerve (PCM) were injured in 8 (13.6%) hands, an injury that is almost unavoidable with the classic open technique.     

Applied anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery

A study of the anatomy of the fasciocutaneous branch of the third perforator artery of the deep femoral artery was performed to help the elaboration of a fasciocutaneous flap for the reconstruction of skin and subcutaneous and deep fascia of the knee and popliteal region.Forty thighs in 27 fresh cadavers were dissected. In all of the thighs, the third perforator artery was found to arise from the deep femoral artery and reach the posterior aspect of the thigh after perforating the adductor magnus muscle. At that point it was also found that the third perforator artery gives off a branch that emerges through the intermuscular septum between the vast lateral muscle and the long head of the biceps femoral muscle, then crosses the posterior cutaneous nerve and moves directly on to perforate the deep fascia and then to bifurcate into two other branches: one ascending and one descending.The cutaneous area of the flap of the thigh’s posterior region, nourished by the fasciocutaneous branch, was evaluated through the injection of dye. Dying of the upper medial, middle medial, lower medial and lower lateral areas of the flap was not successful in all of the dissected thighs. Nevertheless, the upper lateral and the middle lateral areas were dyed successfully in all 40 dissected thighs of the 27 cadavers.     

皮神经营养血管皮瓣在手和足软组织缺损中的应用

目的　应用皮神经营养血管蒂逆行岛状皮瓣修复手和足踝部的软组织缺损。方法　以前臂外侧皮神经、桡神经浅支和腓肠神经为轴线 ,分别根据手或足踝部受区大小、部位及供、受区距离设计出逆行岛状皮瓣。结果　腓肠神经营养血管皮瓣修复足踝部创面 4例 ,前臂外侧皮神经营养血管皮瓣修复虎口部创面 1例 ,桡神经浅支营养血管皮瓣修复拇指软组织撕脱伤 1例 ,皮瓣全部成活。结论　根据皮神经营养血管与皮肤血管相互交通的关系设计出的皮神经营养血管皮瓣 ,为手和足踝部软组织缺损的修复提供了血供可靠、简便快捷的新方法