指背多级推进皮瓣的解剖学研究

目的　通过皮肤的延展性、皮下浅筋膜的滑动性、指固有动脉背侧支的角位移及指固有动脉的弹性等多级推进的方式来增大指背带蒂皮瓣的推进距离修复指背创面。 方法　新鲜成人手标本11侧34指，在手指的中节与近节的背侧分别设计皮瓣，皮瓣的内容包括指背皮肤、皮下浅筋膜、手指一侧指固有动脉以及指固有动脉发出的背侧支。将皮瓣向指背远端推进，皮肤的延展性、皮下浅筋膜的滑动性、指固有动脉背侧支的角位移与指固有动脉的弹性，这4个因素都各自对指背皮瓣推进起到一定作用，通过这4种作用的多级叠加作用增大皮瓣推进距离。 结果　在新鲜标本上模拟的指背多级推进皮瓣的最大推进距离中节指背皮瓣为2.4 cm，近节指背皮瓣4.5 cm。 结论　多级推进式指背皮瓣推进距离明显增加，最大推进距离为4.5 cm，平均距离为2.5 cm，其手术操作安全、简便，是修复指背中小型创面的理想皮瓣之一。

Anatomical study of the dorsal multi-grade advancing flap

Objective　To repair the dorsal wound by increasing the propulsion distance of the dorsal flap through the multi-grade effect of the ductility of the skin, the slip between the subcutaneous superficial fascia and the skin, the angular displacement of the dorsal branch from the proper digital artery and the elasticity of the proper digital artery.　Methods　The skin flaps of 34 fingers on 11 sides of fresh adult cadaveric hands were designed on the dorsal side of the middle and proximal segments of the finger respectively. The contents of the flap included the dorsal skin, the subcutaneous superficial fascia, the proper digital artery on one side of the finger and the dorsal branch of the proper digital artery. When the flap was pushed to the distal end of the finger, the ductility of the skin，the sliding of the subcutaneous superficial fascia,the angular displacement of the dorsal branch of the proper digital artery and the elasticity of the proper digital artery all played a certain role in the advancement of the dorsal finger flap respectively, the advancement distance of the flap can be increased by the multi-grade superposition of these four effects.　Results　The maximum propulsion distance of the dorsal flap simulated on the fresh specimens was 2.4 cm and the dorsal flap in the proximal segment of finger was 4.5 cm.　Conclusions　The advancing distance of the dorsal multi-grade advanced flap increases significantly. The maximum advancing distance is 4.5cm and the average distance is 2.5cm. The operation of the multistage advancing dorsal finger flap is safe and simple, it is one of the ideal flap for repairing small and medium-sized wounds of the dorsal finger.