头静脉营养血管远端蒂复合瓣的解剖学研究

背景:前臂皮神经营养血管远端蒂皮瓣,特别适宜手部远端的组织缺损修复,但由于皮瓣旋转轴点较高,时常难以满足修复手部远侧创伤缺损的需要,还会对供区造成较大的损害。目的:观察前臂桡侧缘远端动脉穿支的解剖走行,为前臂桡侧缘头静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计:单一样本实验。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2004-08/12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。30侧动脉内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:以桡骨茎突为观测标志点,采用游标卡尺、直尺测量血管外径、距离。主要观察指标:①前臂桡侧缘远端的动脉穿支。②头静脉的营养血管。③营养血管与邻近骨、皮和前臂外侧皮神经的血供关系。④头静脉的浅深交通支。结果:前臂桡侧缘远端的动脉穿支来自:桡动脉的皮支6～11支,外径(0.7±0.3)mm;掌浅支的皮支2～6支,外径(0.5±0.3)mm;桡骨茎突返支的皮支1～2支,外径(0.5±0.1)mm;鼻烟壶支的皮支1～2支,外径(0.6±0.2)mm。在桡骨茎突上方8.0～15.0cm,桡动脉肌间隙骨皮穿支1～3支,外径(1.1±0.2)mm,分布桡骨体部中下段的裸露区及相应区域的皮肤。上述动脉穿支均发皮支、筋膜支、骨膜支、头静脉和皮神经远端营养血管支,形成头静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂桡侧缘远端的动脉穿支是头静脉营养血管的来源,营养血管又与邻近的骨、皮和前臂外侧皮神经的营养血管同源,是设计头静脉营养血管远端蒂复合瓣的解剖学基础。以桡骨茎突返支(或鼻烟壶支)为蒂的远端蒂复合瓣,旋转轴点可达腕关节平面,用于转位修复手部远处的组织缺损。

Anatomic research on distally based compound flap pedicled with the nutrient vessels of cephalic vein

BACKGROUND: Distally based flap pedicled with the distal nutritional vessels in forearm is especially suitable for reconstructing the tissue defects in the distal end of hands, while high rotation point cannot satisfy the requirements of reconstructing the distal injuries or defects in hands, and severer lesion may even be caused in the donor site.OBJECTIVE: To study the anatomic proceeding of artery perforators in distal radial margin of forearms, so as to provide anatomic basis for the design of distally based compound flap pedicled with the nutrient vessel of cephalic vein in distal radial margin of forearms.DESIGN: Single sample experiment.SETTING: Center for Clinical Anatomy of the Department of Orthopedics,Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command.MATERIALS: The experiment was conducted in the Laboratory of Center for Clinical Anatomy of Department of Orthopedics, Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command between August and December 2004. The upper extremities of 30 cadavers injected with a mixture of red gelatin into the artery (provided by the Center for Clinical Anatomy of Department of Orthopedics, Fuzhou General Hospital of Chinese PLA of Nanjing Military Area Command) were adopted.METHODS: The vascular external diameter and distance were measured with sliding caliper and ruler with radial styloid process as the marker.MAIN OUTCOME MEASURES: ① The perforator artery in distal radial margin of forearms. ② The nutrient vessels of cephalic vein. ③ The relationship of blood supply between the nutrient vessels and vicinal bone and skin as well as the lateral antebrachial cutaneous nerve. ④ The superficial and deep communicating branches of cephalic vein.RESULTS: The perforator artery in distal radial margin of forearms derived from: 6-11 cutaneous branches of radial artery with external diameter of (0.7±0.3) mm; 2-6 cutaneous branches of superficial palma with the external diameter of (0.5±0.3) mm; 1-2 recurrent cutaneous branches of the styloid process of radius with the external diameter of (0.5±0.1) mm; 1-2 cutaneous branches of snuff tobacco with the external diameter of (0.6±0.2) mm. At 8.0-15.0 cm above radius styloid process there were 1-3 intermuscular cutaneous branches of radial artery with an initial external diameter of (1.1±0.2) mm, distributing in the exposureregion and corresponding skin of middle and inferior segments in radius. The above-mentioned perforator arteries all developed into cutaneous branch, fascia branch, periosteum branch, cephalic vein and nutrient vessel branch of distal cutaneous nerve,and constituted the vascular chain, the by-pass of cephalic vein, vascular chain of cutaneous nerve stem as well as superficial, deep fascias and periosteal vascular net.CONCLUSION: The perforator artery in distal radial margin of forearms is the source of nutrient vessels in cephalic vein, while the nutrient vessels share an isogeny with the nutrient vessels derived from vicinal bone, skin and lateral antebrachial cutaneous nerve, which provide an anatomic basis for designing the distally based compound flap pedicled with the nutrient vessels of cephalic vein. The rotation point of compound flap pedicled with the recurrent branch of radius styloid process (or branch of snuff tobacco) can reach the surface of rotation joint, which can be adopted in the transposition and reconstruction of distal tissue defects in hands.