前臂后皮神经营养血管远端蒂移植复合瓣的解剖学特点

背景: 前臂后皮神经营养血管皮瓣适合手背侧修复, 然而对于其远端蒂复合皮瓣的系统解剖学特点有待深入研究。目的: 对前臂后皮神经营养血管皮瓣进行观察, 探讨低旋转点的前臂后皮神经营养血管远端蒂皮瓣和复合瓣的解剖学特点。设计: 单一样本观察。单位: 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。材料: 实验于2004-10/12 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。研究材料为 30 侧动脉灌注红色乳胶成人上肢标本( 由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提供) 。方法: 将成人上肢标本以尺、桡骨茎突为观测标志点进行显微解剖。重点解剖: 前臂后皮神经营养血管的来源、分支及吻合; 前臂后皮神经营养血管与邻近骨、皮的血供关系。主要观察指标: 前臂后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。结果: 前臂后皮神经营养血管, 近端来自桡侧副动脉穿皮支 2～6 支, 外径(0.6±0.3) mm; 远端来自骨间前动脉腕背支穿皮支 3～5 支, 外径(0.8±0.2) mm; 其他来自骨间后动脉穿皮支 6～9 支, 外径(0.7±0.3) mm。骨间后动脉发外径 0.3～1.0 mm 的肌骨膜支 6～8 支, 分布尺骨骨膜; 骨间后动脉的桡侧骨穿皮支与桡骨中下段裸区的骨膜血管吻合。上述支发出穿皮支、筋膜支、骨膜支和神经营养血管支, 形成皮神经干血管链以及深、浅筋膜和骨膜血管网。结论: 前臂后皮神经营养血管与邻近骨、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, 适宜手背远处的组织缺损的移植修复。

Anatomic study of distally based compound flap pedicled with nutrient vessels of the posterior antebrachial cutaneous nerve

BACKGROUND:Posterior antebrachial skin is beneficial for repairing injury of dorsum,however,the systematic anatomic characteristics of distally based compound flap pedicled with nutrient vessels need to be further studied.OBJECTIVE:To investigate the anatomic characteristics of distally based flap pedicled with nutrient vessels of the posterior antebrachial cutaneous nerve and compound flap.DESIGN:Single sample observation.SETTING:Research Center for Clinical Anatomy,Military Institute of Orthopaedics,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 October to December 2004.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.METHODS:All 30 adults upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna and radius.The following microdissection was emphasized:The origins,branches,distribution and anastomosis of nutrient vessels of the posterior antebrachial cutaneous nerve;The blood supply relationship of nutrient vessels of posterior antebrachial cutaneous nerve and vicinal bone and skin.MAIN OUTCOME MEASURES:The ordgins and branches of nutrient vessels of posterior antebrachial cutaneous nerve,and whose blood supply relationship with vicinal bone and skin.RESULTS:The origin of nutrient vessels of posterior antebrachial cutaneous nerve were as follows:Proximal part:2-6cutaneous perforators of radial collateral artery,with an outer diameter of (0.6±0.3) mm;Distal part:3-5 cutaneous perforators of dorsal carpal branch of anterior interosseous artery,with an outer diameter of (0.8±0.2) mm;Others:6-9cutaneous perforators of posterior nterosseous artery,with an outer diameter of (0.7±0.3) mm.Posterior interosseous artery sent out 6-8 muscle- periosteum branches with an outer diameter of (0.3-1.0) mm,which distribute on ulnar periosteum;Radial bone-skin perforators of posterior interosseous artery anastomosed with periosteal vessels of mid-inferior bare area of radial bone.All above mentioned cutaneous perforators gave off cutaneous branches,fascia branches,periosteal branches and nerve-nutrient vascular branches,all of which formed a vascular chain of cutaneous nervous stem and vascular networks of deep fascia,superficial fascia and periosteum.CONCLUSION:The nutrient vessels of posterior antebrachial cutaneous nerve have the same origins as the vicinal bone-skin nutrient vessels,and the rotation point of its distally based pedicled flap and compound flap can reach the plane of wrist joint,which may be helpful to design a kind of more convenient and simplified flap to repair the distal tissue defects of the hand.