贵要静脉营养血管远端蒂复合瓣的解剖学特征

背景:前臂皮神经营养血管皮瓣特别适宜手部远端的组织缺损修复,所以了解贵要静脉远端的营养血管及与邻近骨、皮和前臂内侧皮神经的血供关系对临床上前臂皮神经营养血管远端蒂复合瓣的设计有重要意义。目的:研究前臂尺侧缘远端的动脉穿支,为前臂尺侧缘贵要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2004-05/10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。研究材料为30侧动脉灌注红色乳胶成人上肢标本(由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:将30侧成人上肢标本,以尺骨茎突为观测标志点进行显微解剖。主要观察指标:重点观察:①前臂尺侧缘远端的动脉穿支来源。②动脉穿支与贵要静脉远端的营养血管。③营养血管与邻近骨、皮和前臂内侧皮神经的血供关系。④贵要静脉的浅深交通支。结果:①前臂尺侧缘远端的动脉穿支来自:尺动脉的皮支5～9支,外径(0.7±0.3)mm,尺动脉腕上皮支1～3支,外径(0.6±0.3)mm。在尺骨茎突上方6.0～16.0cm,骨间前动脉发骨皮穿支二三支,骨间后动脉发骨皮穿支1～3支,二者外径在0.4～1.2mm,分布尺骨中下段骨膜及相应区域的皮肤。②上述动脉穿支均发皮支、筋膜支、骨膜支、贵要静脉和皮神经营养血管支,形成贵要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:前臂尺侧缘远端的动脉穿支是贵要静脉营养血管的来源,营养血管与邻近的骨、皮和前臂内侧皮神经的营养血管同源,是设计贵要静脉营养血管远端蒂复合瓣的解剖学基础。以尺动脉腕上皮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。

Anatomical characteristics of the distal pedicled flap of nutrient vessel in basilic vein

BACKGROUND: Skin flap of nutrient vessel of antebrachial cutaneous nerve is beneficial for repairing injury of distal tissue of hand; thus, it is important for comprehending the correlation of blood supply between distal nutrient vessel of basilic vein and medial cutaneous nerve of bone, skin and forearm to design distal pedicled flap of nutrient vessel of antebrachial cutaneous nerve on clinic. OBJECTIVE: To investigate distally arterial perforating branch of ulnar margin of forearm and provide anatomical bases for designing distal pedicled flap of nutrient vessel in basilic vein of ulnar margin of forearm. DESIGN: Simple sample study. SETTING: Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA. MATERIALS: The experiment was carried out at the Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of PLA from May to October 2004. Thirty upper limbs of adult cadavers perfused with red latex through arteries were provided by Researching Center of Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospitalof Nanjing Military Area Command of PLA. METHODS: Samples of lateral upper limbs of 30 adults were dissected as the pivot point of styloid process of ulna with microscope. MAIN OUTCOME MEASURES: ① Sources of distally arterial perfo- rating branch of ulnar margin of forearm; ② nutrient vessel between perfo- rating branch and basilic vein; ③ correlation of blood supply between nutrient vessel and medial cutaneous nerve of bone, skin and forearm; ④ superficial and deep communicating branch of basilic vein. RESULTS: ① Sources of distally arterial perforating branch of ulnar margin of forearm, which was derived from 5-9 cutaneous branches ulnar artery with external diameter of (0.7±0.3) mm, 1-3 upper cutaneous branches ulnar artery with the external diameter of (0.6±0.3) mm, 6.0- 16.0 mm above styloid process of ulna, 2-3 cutaneous perforating branches anterior interosseous artery and 1-3 posterior interosseous artery with external diameter of 0.4-1.2 mm, middle and inferior segment of periosteum of ulnar and skins in corresponding areas. ② Arterial perforating branches mentioned above started at cutaneous branches, fascia branches, periosteum branches, basilic vein and nutrient vessel branches of cutaneous nerve to form vascular chains of basilic vein and cutaneous nerve stem and vascular nets of deep, superficial fascia and periosteum. CONCLUSION: Nutrient vessel of basilic vein is derived from distally arterial perforating branch of ulnar margin of forearm, and this is homophylic with that of medial cutaneous nerve of bone, skin and forearm. Both of them are anatomical basis to design distal pedicled flap of nutrient vessel in basilic vein. Rotational point of distal pedicled flap can reach wrist joint. The compound flap can be applied to repair to injury of distal tissue of hand.