指动脉背侧支皮瓣的解剖学基础及临床应用

目的　探讨指动脉背侧支皮瓣血管解剖学基础及临床应用经验。 方法　5侧成人新鲜上肢标本经动脉红色乳胶灌注并解剖，观察指动脉背侧支的起始处外径，走行距离及吻合支情况。1侧成人新鲜上肢标本经氧化铅灌注，分别于灌注后2、4h行X线片摄影，观察指动脉背侧支走行、分布情况。临床上设计切取以指动脉背侧支为蒂的游离皮瓣修复指腹皮肤软组织缺损共6例6指。 结果　指动脉背侧支发出部位比较恒定，分别在近节指中段、近节中远1/3、中节中段及远指间关节平面，其中以近节中远1/3处的皮支发出最为恒定，起始处外径约为0.2mm。临床设计游离皮瓣6例6块修复指腹软组织缺损，皮瓣全部成活。术后随访6~18月（平均12月），皮瓣血运、质地、弹性良好，外形美观，感觉恢复S3，对供区损伤小。 结论　指动脉背侧支解剖恒定，供血可靠，以指动脉背侧支为蒂的游离皮瓣修复指腹创面是一种理想的方法，临床上可依具体情况选择来修复。

The flap based on the dorsal branch of the digital artery:anatomy and clinical application

Objective To investigate blood supply features of the flap based on the dorsal branch of the digital artery and summarize clinical experience.Methods 5 fresh adult upper limb specimens were injected with red latex via artery and were dissected.The origin outer diameter,the course and anastomosis of the dorsal branch of the digital artery were measured and observed.Distribution features of dorsal branch of the digital artery was further explored on X-ray images collected from one fresh adult upper limb specimen injected with lead oxide.Free flaps of dorsal branch of the digital artery were used to repair soft tissue defects of finger pulp(6 fingers of 6 patients).Results The origin of the dorsal branch of the digital artery was relatively constant,and respectively located at the middle of proximal phalanx,the middle distal 1/3 of proximal phalanx,the middle of second phalanx and the distal of interphalangeal joints.Among them,the origin branch in the middle distal 1/3 of proximal phalanx was constant,with the outer diameter of 0.2mm.6 to 18 months’ follow-up proved that,6 flaps survived well,with good blood supply,texture,flexibility and appearance.The sensory recovery reached S3 level.Conclusions The dorsal branch of the digital artery is less variant.It is an ideal selection for prepare free flaps to repair soft tissue defect of finger pulp.