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／     

前臂外侧皮神经营养血管远端蒂筋膜皮瓣的解剖和临床应用

目的 观察前臂外侧皮神经营养血管皮瓣的血供和临床应用的可行性。 方法 用３７侧成人上肢标本,对前臂外侧皮神经营养血管的来源,行径,分支分布及其与头静脉的关系等进行解剖观察,并设计了前臂外侧皮神经营养血管远端蒂筋膜皮瓣,应用于临床修复手背疱痕切除后遗留创面。结果 前臂外侧皮神经前支与头静脉紧密伴行,其全程由４支节段性皮动脉发支营养。     

前臂皮神经、皮神经营养血管与浅静脉的关系和临床意义的解剖学研究

目的　为临床设计皮神经营养血管皮瓣和对该类皮瓣与某些局部移转的静脉皮瓣的关系的认识提供解剖学基础。方法　用显微解剖法、标本双色透明法观测前臂内侧皮神经血供、贵要静脉与前臂内侧皮神经及其营养血管的关系和前臂外侧皮神经的血供、头静脉与前臂外侧皮神经及其营养血管的关系。结果　前臂内、外侧皮神经的血供形式不相同 ,前者由神经旁血管供养 ,后者由主要动脉和神经旁血管共同供养。头静脉与前臂外侧皮神经及其营养血管 ,贵要静脉与前臂内侧皮神经及其营养血管三者相伴行 ,皮神经与浅静脉干距离一般不超过 1cm ,神经旁血管与浅静脉干距离约 0 3～ 1 2cm。结论　顺沿浅静脉干可切取皮神经营养血管皮瓣 ;前臂内侧皮神经营养血管皮瓣与前臂外侧皮神经营养血管皮瓣蒂部形式应有所不同 ;某些局部移转的静脉皮瓣可能是皮神经营养血管皮瓣。     

前臂外侧皮神经营养血管远端蒂皮瓣的临床应用

目的报道前臂外侧皮神经营养血管远端蒂皮瓣的临床应用疗效。方法根据前臂外侧皮神经营养血管皮瓣血供来源及其与前臂筋膜皮肤血供的相互关系，在前臂外侧设计皮神经营养血管远端蒂皮瓣，转位修复手部、腕部及前臂远端软组织缺损19例。结果术后皮瓣完全成活，创面一期愈合，经3～30个月随访，皮瓣外形与手部功能恢复满意。结论前臂外侧皮神经营养血管远端蒂皮瓣解剖位置恒定，血液供应良好，手术方法简单，适用于修复手部、前臂软组织的缺损。     

前臂皮神经,皮神经营养血管与浅静脉的关系和临床意义？…

目的 为设计皮神经营养血管皮瓣和对该类皮瓣与某些局部移转的静脉的的关系的认识提供学基础。方法 用显微解剖法,标本双色透明法观测前臂内侧皮神经血供、贵要静脉与前臂内侧皮神经及其营养血管的关系和前臂外侧皮神经的血供、头静脉与前外侧皮神经及其营养血管的关系。结果 前臂内、外侧皮神经的血供形式不相同,前者由神经旁血管供养,后者由主要动脉和神经旁血管共同供养。头静脉与前外侧皮神经及其营养血管,贵要静脉与前后     

前臂外侧皮神经营养血管皮瓣在虎口缺损中的临床应用

最近有关皮神经营养血管皮瓣的文章较多。本期有二篇采用前臂外侧皮神经营养血管皮瓣修复手部创面的文章。 皮神经营养血管皮瓣是筋膜皮瓣的特殊类型。由于皮神经是沿肢体纵轴走行，故若筋膜皮瓣带有皮神经，则必然带有皮神经营养血管。使皮神经营养血管皮瓣在纵轴方向切取范围大于一般筋膜皮瓣。但皮神经营养血管切取时。其蒂部应包含穿支血管，故有些文章又将此类皮瓣称为穿支皮瓣。穿支皮瓣是指动脉穿过深筋膜后其口径仍足以进行显微外科吻合的皮瓣。其穿支血管可以是肌间隔穿支或肌肉皮肤穿支。带蒂转移穿支皮瓣多属于肌间隔穿支皮瓣，临床应用最多的是以四肢主干动脉发出的最远侧肌间隔穿支（均在腕、踝关节上5cm左右）为血供的远端蒂皮瓣。因此，临床上在设计和切取此类皮瓣时．应同时注意皮神经营养血管和穿支血管对皮瓣的血供作用。[编者按]     

带皮穿支血管上臂内侧皮神经营养血管皮瓣的应用

目的 探讨带皮穿支血管上臂内侧皮神经营养血管皮瓣的临床应用疗效.方法 根据臂内侧深部知名血管的皮肤穿支血管和皮神经营养血管皮瓣血供来源及其与上臂筋膜皮肤血供的相互联系,在上臂内侧设计皮穿支血管皮神经营养血管皮瓣修复肩、臂、肘关节等部位皮肤缺损5例.结果 术后皮瓣完全成活,创面一期愈合,经6～12个月随访,皮瓣外形与肩、肘关节功能恢复满意.结论 带皮穿支血管的上臂内侧皮神经营养血管皮瓣解剖位置恒定、血供良好,手术方法简单,是修复上肢皮肤缺损的一种可取的方法.     

腓肠外侧动脉穿支与腓肠外侧皮神经营养血管联合蒂肌皮瓣的临床应用

目的 观察腓肠外侧动脉穿支与腓肠外侧皮神经营养血管的解剖位置关系,并设计二者联合蒂肌皮瓣,通过临床应用探讨其临床效果.方法 在5具(10侧)成人下肢新鲜标本上,观测记录腓肠外侧动脉穿支与腓肠外侧皮神经营养血管的解剖位置关系;并据此设计二者联合近端蒂肌皮瓣,临床应用5例,皮瓣大小6cm ×9 cm～9cm×12cm.结果 腓肠外侧动脉入肌后沿途发出3～5支外径为0.2～1.8 mm的肌皮穿支,营养腓肠肌外侧头及周围皮肤,并与腓肠外侧皮神经营养血管参与形成浅、深筋膜血管网.自2009年2月至2011年11月,临床应用5例腓肠外侧动脉与腓肠外侧皮神经营养血管轴联合蒂肌皮瓣修复膝前及胫骨上端皮肤缺损,4例一期愈合,1例远端部分浅表坏死,经换药逐渐愈合.结论 设计的联合蒂肌皮瓣有两套血供,血运丰富,扩大了皮瓣切取面积;同时皮瓣内带有感觉神经,保证了皮瓣感觉,可以修复膝关节周围较复杂皮肤软组织缺损.皮瓣蒂部不臃肿,转移方便,不损伤主要血管,创伤小,易于临床推广应用.     

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。     

带皮穿支血管的皮神经营养血管皮瓣的临床应用

目的探讨带皮穿支血管与皮神经营养血管相结合的皮瓣手术方法及临床应用效果。方法以深部知名血管发出的皮肤穿支为皮瓣转轴点,切取皮神经营养血管带蒂皮瓣或岛状皮瓣,转位修复肢体远端皮肤软组织缺损创面。结果临床已应用43例,其中腓动脉穿支腓肠神经营养血管皮瓣13例,面积30 cm×12 cm~16 cm×8 cm;胫后血管穿支隐神经营养血管皮瓣9例,面积17 cm×9 cm~5 cm×4 cm;以骨间前血管腕背穿支前臂背侧皮神经营养血管皮瓣8例,面积16 cm×6 cm~10 cm×4 cm;以掌指动脉指蹼穿支手背皮神经营养血管逆行皮瓣13例,皮瓣面积6.0 cm×3.5 cm~2.5 cm×1.5 cm;皮瓣完全成活42例,1例因静脉回流障碍远端1/4坏死。随访6~24个月,皮瓣质地优良,外形与功能恢复满意。结论该术式结合了穿支蒂皮瓣与皮神经营养血管皮瓣的优点,扩大了皮瓣切取面积与修复范围,皮瓣设计灵活,切取方便,血供可靠,是修复肢体皮肤软组织缺损的一种可取的方法。     

肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣的解剖基础

目的 为肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣修复肘部软组织缺损提供解剖学基础.方法在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观查:①前臂外侧皮神经的走行与分布;②肘下动脉与前臂外侧皮神经营养血管间吻合关系.另在1侧新鲜标本上进行摹拟手术设计.结果①前臂外侧皮神经主干行于前臂桡侧,分布于前臂外侧1/3区域;②营养血管为多节段、多源性,其中肘下动脉的位置相对恒定,在头静脉与深静脉系统的交通支形成的倒"V"状顶点到达皮肤,并分出众多的细小血管与前臂外侧皮神经的神经旁和神经干血管链的分支密切吻合.结论 可形成肘下动脉穿支蒂前臂外侧皮神经营养血管皮瓣顺行转位修复肘部软组织缺损.

Abstract：

Objective To provide anatomical basis for lateral antebrachial neurocutaneous flap pedi-cled with inferior cubital artery perforator in repairing tissue defects around elbow joint. Methods Thirty embalmed upper limbs of adult cadavers perfused with red latex were used for this study, and followings were observed:①The course and distribution of lateral antebrachial cutaneous nerve; ②Anastomoses between inferior cubital artery and nutrient vessels of lateral antebrachial cutaneous nerve. Mimic operation was performed on other side of fresh specimen. Results ①The main trunk of lateral antebrachial cutaneous nerve (LACN) lined in the radial forearm and distributed in the 1/3 region of lateral forearm. ①The nutritional vessels of the flap were plurisegmental and polyphyletic. The inferior cubital artery which was relatively constant reached to skin through "V"-shaped peak formed by communicating branches of cephalic vein and deep venous system. They also gave off large number of small veins, which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. Conclusion The lateral antebrachial neurocutaneos flap pedicled with inferior cubital artery perforator can be formed to repaire tissue defects around elbow joint.     

隐神经-大隐静脉营养血管与逆行胫后动脉皮支蒂复合瓣在足跟部瘢痕修复中的应用

目的：探讨应用隐神经-大隐静脉营养血管与逆行胫后动脉皮支蒂复合瓣修复足跟部瘢痕的疗效。方法：应用隐神经-大隐静脉营养血管与逆行胫后动脉皮支为蒂的复合瓣修复足跟部瘢痕共11例。设计的皮瓣面积为6cm×8cm～9cm×16cm。结果：11例患者皮瓣全部成活,创面Ⅰ期愈合,术后随访患者3～24个月,均取得满意效果。结论：隐神经一大隐静脉营养血管与逆行胫后动脉皮支蒂复合瓣相对较长,血供可靠,皮瓣可切取面积大,是修复足跟部瘢痕的理想皮瓣。     

Combined use of the cephalic vein and pectoralis major muscle flap for secondary esophageal reconstruction

Secondary reconstruction of thoracic esophageal defects is a challenging problem for microsurgeons. Because of previous surgeries and coexisting disease, gastric pull‐up, and creation of a pedicled colon conduit are often impossible. Transfer of a supercharged pedicled jejunum flap or free jejunal interposition is usually the last resort; however, identifying appropriate recipient vessels and adequately covering the reconstructive conduit are often difficult. We performed secondary thoracic esophageal reconstruction with combined use of the cephalic vein as a recipient vein and the pectoralis major muscle flap for coverage in three patients. Two patients underwent transfer of a supercharged pedicled jejunum flap, and the other patient underwent free jejunal interposition. No wound complications occurred, and all patients could resume oral intake. The cephalic vein is a more reliable recipient vein than is the internal mammary vein. The skin graft‐covered pectoralis major muscle flap provides secure external coverage to prevent anastomotic leakage even in complicated cases. Combined use of the cephalic vein and the skin graft‐covered pectoralis major muscle flap is a versatile option for secondary thoracic esophageal reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery 34:319–323, 2014.     

Vessel-depleted neck: techniques for achieving microvascular reconstruction

BACKGROUND: In the neck, the recipient vessels most frequently used for microsurgical reconstruction are compromised by prior surgery and radiation. METHODS: We conducted a retrospective chart review of all patients who underwent microvascular reconstruction between July 2001 and June 2005. Donor vessels, vein grafts, and flap survival were examined. RESULTS: Fourteen of 197 patients (7%) were identified with a vessel-depleted neck. All patients had undergone a prior neck dissection and radiation (100%) or chemoradiation (42%). Free flap revascularization was achieved using the transverse cervical artery with a vein graft and a cephalic vein (4 patients), thoracoacromial artery and cephalic vein (3 patients), internal mammary artery and vein (3 patients), and inferior thyroid artery and cephalic vein (1 case). In 3 patients, the reverse flow thoracodorsal artery and cephalic vein were used to vascularize the scapular flap. CONCLUSION: The cephalic vein, transverse cervical, internal mammary, and thoracoacromial vessels represent reliable alternatives in the vessel-depleted neck.     

颞浅血管为蒂的耳后岛状皮瓣再造眼窝

自1988年10月以来,应用以颞浅动脉为轴型血管的耳后皮瓣岛状移位,进行眼窝再造6例,术后皮瓣全部成活,疗效满意。该皮瓣供区隐蔽,蒂长,瓣薄,血供可靠,成活率高,是眼窝再造的理想材料。文中介绍了皮瓣的设计和手术方法。     

旋髂深血管蒂骨膜瓣与旋股外血管蒂阔筋膜张肌髂骨瓣复合移植治疗成人股骨头缺血性坏死

目的观察旋髂深血管蒂骨膜瓣与旋股外侧血管蒂阔筋膜张肌髂骨瓣复合移植治疗成人股骨头缺血性坏死的疗效。方法采用旋髂深血管蒂骨膜瓣与旋股外侧血管蒂阔筋膜张肌髂骨瓣复合移植至4例坏死塌陷的股骨头内重建病变的股骨头。结果按髋关节功能Harris评分标准进行评价，对4例进行2-3年随访，优3例，良1例。结论本复合骨瓣对重建股骨头坏死的血运是可靠的方法。     

Cephalic vein-pedicled arterialized anteromedial arm venous flap for head and neck reconstruction

The authors describe a case of transfer of an arterialized cephalic venous flap from the anteromedial arm region to the neck with the cranial limb of the cephalic vein serving as the drainage vein and a pedicle. The burn scar contracture of a 45-year-old man was released and repaired with a venous flap based on the cephalic vein in the anteromedial arm. After dissection of the cranial end of the cephalic vein as a drainage vein in the deltopectoral groove, until the flap could be transposed easily to the neck defect pedicled on the dissected cranial limb of the cephalic vein, the flap was arterialized by anastomosing the caudal end of the cephalic vein to a recipient artery in the neck The donor defect was skin grafted and the flap survived completely. The neck contracture improved substantially.     

The temporalis osteomyoperiosteal flap its blood supply and use for reconstruction of the maxilla

Summary A technique for one-stage reconstruction for bony and soft tissue repair after subtotal bilateral maxillectomy is reported. A one-side pedicled temporalis osteomyoperiosteal flap is used for reconstruction of oral and nasal lining, maxillary bone, and oral, as well as nasal, soft tissue lining of the velum. Cadaver dissections, injection studies, and histological investigations were performed to investigate the blood supply of the temporoparietal osteomyoperiosteal region, especially directed to the temporoparietal periosteum via the deep temporal vessels. Both blood supply systems, the superficial temporal and the deep temporal arteries guarantee sufficient blood circulation of the temporoparietal periosteum because of abundant anastomoses between both systems. Principles of flap design, elevation and transfer to the midfacial area are demonstrated in cadavers and in the clinical example. The experimental part of this paper was presented at the 8th Congress of the European Association of Maxillofacial Surgery in Paris in September of 1984.