桡动脉掌浅支皮瓣解剖基础与临床应用进展

目的 总结桡动脉掌浅支皮瓣的解剖基础与临床应用进展。方法 在PubMed、Science Direct、CNKI和万方数据等数据库以“桡动脉掌浅支、鱼际、腕横纹、外科皮瓣、皮肤缺损”为关键词检索2000年1月—2016年11月有关桡动脉掌浅支皮瓣的相关文献,分别对桡动脉掌浅支的解剖研究、皮瓣设计、临床分型、适用范围及优缺点等方面的最新研究进展进行归纳和总结。结果 桡动脉掌浅支可分为鱼际皮支与腕横纹皮支,走行恒定,血供可靠;两个皮支直径均与手指动脉直径相近,有利于与指动脉相吻合。临床上可在鱼际部与腕横纹部分别设计切取岛状皮瓣与游离皮瓣,修复手部中小面积的各种皮肤软组织损伤;对于合并神经、血管的复合损伤,还可切取Flow-through皮瓣或携带神经、肌腱的嵌合皮瓣,完成一期创面覆盖与功能重建。桡动脉掌浅支皮瓣优点颇多,但对于皮瓣的切取面积范围及具体神经支配情况尚未有统一意见。结论 以桡动脉掌浅支供血的皮瓣切取方式多,修复效果好,适用范围广,临床值得推广,但现有报道中对于皮瓣切取面积及神经支配情况未有详细证据,需进一步研究探讨。

Research progress on anatomical basis and clinical application of the superficial palmar branch of the radial artery flap

Objective To summarize anatomical basis and clinical classification of the superficial palmar branch of the radial artery flap.Methods The references related to superficial palmar branch of the radial artery flap were searched by using “superficial palmar branch of the radial artery” “thenar eminence” “wrist crease”“surgery flap”and “finger skin defect” as the key words in the PubMed, Science Direct CNKI, and Wanfang Data from January 2000 to November 2016. The anatomical study, Flap design, clinical classification, range of application and the advantages and disadvantages of the superficial palmar branch of the radial artery flap were summarized.Results The superficial palmar branch of the radial artery can be divided into branch of thenareminence and branch of wrist crease, the course of it is constant, blood supply is reliable, the both branchesvessel diameter is similar to the digitalesvolarespropriae artery.The flap can be designed and cut at thenareminence or wrist crease, divided into island flap or free flap to repair the small and medium-sized area of finger soft tissue defect; Flow-through flap and chimeric flap can be cut and design to repair the complex soft tissue defects of fingers for the wound surface coverage and functional reconstruction. But there was no consensus on the point of view of the area range and innervation of the flap.Conclusions The superficial palmar branch of the radial artery flap has many ways to cut, satisfactory repair effect suitable and extensive range of application, which is worthy of spreading. But the area range and innervation of the flap are still unclear, and need to be explored by further study.