第1掌背动脉逆行岛状皮瓣的应用解剖学

目的　提供第1掌背动脉逆行岛状皮瓣的应用解剖学依据。 方法　解剖58侧防腐固定的成尸手标本，观测第1掌背动脉的起源、外径、长度及吻合。观察皮瓣感觉神经的来源及分布。1侧新鲜成尸手标本动脉造影。 结果　第1掌背动脉起于桡动脉鼻烟窝段，外径（0.77±0.19）mm，长度（5.21±　0.47）cm。第1掌背动脉分为3型：Ⅰ正常型占60%（35侧），走行在第2掌骨桡侧，在第2掌骨颈或示指近节桡侧与示指桡掌侧固有动脉吻合。Ⅱ变异型占29.2%（17侧），Ⅲ缺如型占10.3%（6侧）。第1掌背动脉伴行静脉两支者占29%（17侧）；1支者占19%（11侧）；缺如占52%（30侧）。皮瓣的感觉神经来源于桡神经浅支。 结论　第1掌背动脉作为轴心血管设计为逆行岛状皮瓣修复拇指、示指近节及掌指关节背侧皮肤缺损。

Applied anatomy of the first dorsal metacarpal artery reversed isand skin flap

Objective　To provide anatomic basis for clinic application of the first metacarpal artery retrograde island flap. Methods The origin, diameter, length and anastomosis of the first metacarpal artery were explored and observed in 58 sides of fixed adult cadaveric hand specimen. The origin and distribution of cutaneoud nerve related to the flap were observed. Arteriography was used in one side of a fresh adult hand specimen to observe the first metacarpal artery. Results The first metacarpal artery originated from snuffbox segment of radial artery, with the diameter and the length of（0.77±0.19）mm and (5.21±0.47)cm separately. The first metacarpal artery could be divided into three types: 35 sides(60%) were normal type, artery located at the radial side of the second metacarpal and anastomosed with the radial proper digital artery of index finger at second metacarpal cervix or radial side of the proximal phalanx of the index finger; 17 sides(29.2%) were variation type, and 6 sides(10.3%) were absence type. The first metacarpal artery accompanied with two veins(17 sides, 29%)，or with single vein( 11 sides, 19%）, or without vein(30 sides, 52%）.The sensory nerves of the flap area originated from superficial radial nerve. Conclusions Taken as the axis artery, the first metacarpal artery can be used to prepare reversed island flap to repair soft tissue defect in proximal thumb and index finger or dorsal metacarpophalangeal joint.