前臂内侧皮神经-贵要静脉营养血管远端蒂复合瓣转位移植修复手部缺损

背景:前臂内侧皮神经营养血管皮瓣适合手部修复,但需要远端蒂复合皮瓣的系统解剖学研究的支持。目的:分析前臂内侧皮神经-贵要静脉营养血管远端蒂复合瓣的解剖学基础。设计:单一样本观察。单位:解放军南京军区福州总医院军区临床解剖学研究中心。材料:实验于2003-03/08在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。选用30侧成人上肢新鲜标本,由解放军南京军区福州总医院军区临床解剖学研究中心提供,经肱动脉内灌注入红色乳胶,直至指端的细小动脉染色,使之充分显示小血管的分支、分布和吻合。方法:以尺骨茎突为观测标志点,重点显微解剖:①前臂内侧皮神经-贵要静脉下1/3段的营养血管来源、分支分布、吻合及其与尺骨骨膜血管的关系。②贵要静脉浅深交通支。主要观察指标:①前臂内侧皮神经营养血管的来源、分支、吻合及其与邻近骨、皮的血供关系。②贵要静脉浅深交通支。结果:①在前臂的下1/3段,前臂内侧皮神经-贵要静脉的营养血管来自尺动脉穿皮支5￣9支,外径(0.7±0.3)mm;尺动脉腕上支的升支、降支沿途发数皮支营养贵要静脉,外径(0.6±0.3)mm。在尺骨茎突上6.0￣16.0cm之间,骨间前动脉发骨皮穿支2￣3支,外径(0.7±0.2)mm;骨间后动脉发骨皮穿支1￣3支,外径(0.6±0.3)mm。二者分布尺骨中下段骨膜及相应区域的皮肤。上述穿皮支均发皮支、筋膜支、骨膜支、皮神经-浅静脉营养血管支,形成皮神经干血管链和贵要静脉旁血管链以及深、浅筋膜和骨膜血管网。②尺动脉有两条伴行静脉,一粗一细伴行动脉两侧,动脉皮支的伴行静脉汇入。尺动脉腕上皮支的2条伴行静脉,一端汇入尺静脉的尺侧支,另一端与腕上皮支同穿深筋膜入皮下,直接汇入贵要静脉,汇入部位在尺骨茎突上(2.3±0.8)cm,外径(2.8±0.5)mm。结论:前臂内侧皮神经-贵要静脉的营养血管与骨、皮营养血管同源,其远端蒂皮瓣、复合瓣的旋转轴点可达腕关节平面,适用于转位修复手部远处的组织缺损。

Distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve- basilic vein for repairing the hand defect

BACKGROUND: Flap pedicled with nutritional vessels of the cutaneous antebrachial medialis nerve is beneficial for repairing injury of dorsum of hand; but it needs the support from systemic anatomic research on distally based compound flap.OBJECTIVE: To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve -basilic vein.DESIGN: Single sample observation.SETTING: Research Center for Clinical Anatomy, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS: The experiment was carried out at the laboratory for Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March to August 2003. A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. Each cadaver was injected with a mixture of red gelatin to show the branches, distributions and anastomosis of the lesser vessels on the stained small arteries of the finger tips.METHODS: All 30 adult upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna: ①The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of medial antebrachial cutaneous nerve-basilic vein, and whose blood supply relationship with ulnar periosteal vessels. ②The superficial and deep communicating branches of basilic vein.MAIN OUTCOME MEASURES: ①The origins, branches, distribution and anastomosis of nutrient vessels of medial antebrachial cutaneous nerve, and whose blood supply relationship with vicinal bone and skin. ② The superficial and deep communicating branches of basilic vein.RESULTS: ①The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were 5-9 cutaneous branches of ulnar artery with an outer diameter of (0.7±0.3)mm. The ascending and descending branches of wrist superior branches sent out several cutaneous branches nourishing basilic vein, with an outer diameter of (0.6±0.3) mm. Between the position of (6.0-16.0) cm superior to ulnar malleolus, anterior interosseous artery sent out 2-3 perforating bone-skin branches, with an outer diameter of (0.7±0.2) mm; Posterior interosseous artery sent out 1-3 bone-skin perforating branches, with an outer diameter of (0.6±0.3) mm. Both of them were distributed on periosteum and skin of the corresponding area. All above-mentioned cutaneous perforators gave off cutaneous branches, fascia branches, periosteal branches and nutrient vascular branches of cutaneous nerve-superficial vein, and a vessel chain of cutaneous nerve-basilic vein and vascular networks of deep fascia, superficial fascia and periosteum formed. ②Ulnar artery had two accompanying veins, one was grossus, and the other thin. The two veins accompanied along two sides of artery, and the accompanying vein of arterial cutaneous branches infused. Superior wrist cutaneous branches of ulnar artery had two accompanying veins. One pumped into ulnar branch of ulnar vein, and the other one passed through deep fascia, then entered subcutaneous tissue, and straightly pumped into basilic vein. The injected position was (2.3±0.8) cm superior to ulnar malleolus, with an outer diameter of (2.8±0.5) mm.CONCLUSION: The nutrient vessels of medial antebrachial cutaneous nerve-basilic vein and the nutrient vessels of bone and skin are homologous. The rotation point of their distally based pedicled flap and compound flap can reach the plane of wrist joint, which can be applied to repair the distal tissue defects of the hand.