第二和第三掌背动脉皮支皮瓣的应用解剖

目的为掌背动脉远段皮支皮瓣的设计提供解剖学依据。方法在10侧成人手标本动脉乳胶灌注后,解剖观测第2、3掌背动脉走行,皮支的起始部位、走行、外径和吻合方式,模拟掌背动脉皮支皮瓣的切取方法。结果第2、3掌背动脉位置恒定,其皮支发出部位主要集中在远1/3段,直径大于0.2mm者占15%,小于0.2mm占85%,可解剖长度大于20mm;在指蹼处指蹼动脉1～3支,大于0.3mm者为1支,可解剖长度超过10mm。结论以掌背动脉远段皮支为蒂可设计顺行或逆行皮支皮瓣,修复近、中手指皮肤缺损。以指蹼动脉为蒂的顺行皮瓣可修复近、中节手指掌侧皮肤缺损。皮瓣面积以不超过20mm×40mm为宜。

Applied anatomy of the design of the dorsal metacarpal flap with cutaneous branches of dorsal metacarpal artery

Objective To explore the anatomical basis of the design of the dorsal metacarpal flap with cutaneous branches of dorsal metacarpal artery. Methods Data of anatomy was collected from 10 sides adult specimens of hand with arterial red latex. The courser of the 2nd and the 3rd dorsal metacarpal arteries, the origin, courser, diameter and anastomosis style of the cutaneous branhes were observed to design the dorsal metacarpal flap with cutaneous branches of dorsal metacarpal artery. Results The 2nd and the 3rd dorsal metacarpal artery liesin constant position, and the orgin of cutaneous branches mainly concentrated in the distal 1/3 of dorsal metacarpal artery. The arteries whose diameter largcr than 0.2 mm account for 15% and those smaller than 0.2 mm auount for 85%. and the length of visible to the naked eye is more than 20 mm. There are one to there communicating branches in the fingerweb, and the diameter of one of them is more than 0.3 mm, and the length which can be free is more than 10 mm. Conclusion The skin defects of proximal and middle segment of the dorsal of fingers can be repaired with the cutaneous branch of the dorsal metacarpal artery flaps by made antegrade or retrograde flaps. The skin defects of proximal and middle segment of the palmar portion of fingers can be used as communicating branches in the fingerweb. It is suitable for flap area smaller than 20 mm × 40 mm.