第一掌骨背侧血管蒂岛状皮瓣的应用解剖

目的研究第一掌骨背侧４种血管蒂岛状皮瓣的应用解剖学基础。方法对３２只新鲜尸手标本，分别行血管染料灌注、血管造影、透明标本后，进行显微解剖学观察。结果（１）桡动脉腕背支、拇指桡侧指背动脉、第一掌背动脉的拇指尺侧支、拇指桡掌侧动脉掌指关节周围支、拇主要动脉分出的拇指尺侧指背动脉等５支血管，共同构成第一掌骨背面区域筋膜层的血管网；并与拇指背皮神经呈节段性伴行。（２）供区内有２条同行浅静脉干，存在静脉瓣膜。结论该供区可设计成拇指桡侧指背动脉、拇指桡侧血管筋膜蒂、拇指尺侧指背动脉筋膜蒂和拇指背皮神经伴行血管蒂等４种类型的岛状皮瓣，可顺行或逆行移位修复创面。

Anatomic study of the island flaps on the dorsum of the first metacarpal

Objective To investigate the anatomical basis for four types of island flaps from the dorsum of the first metacarpal. Methods32 hands of fresh adult cadavers were studied. Vascular perfusion with dye,angiography,and specimen transparency were performed before microsurgical anatomy study was carried out. Distribution of the blood vessels and the concomitant cutaneous nerves were observed. Results 1. At the dorsal aspect of the first metacarpal, a vascular network in the fascial layer is formed by the vessels as follows:(1) the dorsal carpal branch of the radial artery;(2) the radial dorsal digital artery of the thumb;(3) the ulnar branch of the first dorsal metacarpal artery to the thumb;(4) the collateral branch of the radial palmar artery of the thumb distributing to the MP joint;(5) the ulnar dorsal digital artery of the thumb arising from principal pollicis artery. The vascular network had segmental concomitance of the dorsal superficial nerves of the thumb. 2. In this area, there were two accompanying superficial veins with venous valves. Conclusions Four types of island flaps,based on the radial dorsal digital artery of the thumb, the fascial vascular pedicle of the radial aspect of the thumb, the ulnar branch of the first dorsal metacarpal artery of the thumb, or the neurovascular pedicle from the dorsum of the thumb, can be harvested from the dorsum of the first metacarpal for coverage of tissue loss.