前臂内侧皮神经——贵要静脉营养血管远端蒂复合皮瓣的应用解剖

Applied anatomy of distally based compound flap pedicled with nutritional vessels of the medial cutaneous nerve of forearm

目的为前臂内侧皮神经—贵要静脉营养血管远端蒂复合瓣设计提供解剖学基础。方法对30侧动脉灌注红色乳胶的成人上肢标本,解剖观测下1/3段前臂内侧皮神经-贵要静脉营养血管的来源、分支及其与尺骨膜血管的关系。结果下1/3段前臂内侧皮神经-贵要静脉营养血管来自:尺动脉皮支5～9支,外径(0.7±0.3)mm,尺动脉腕上皮支外径(0.7±0.2)mm。在尺骨茎突上(6.0～16.0)cm,骨间前动脉骨皮穿支2～3支,外径(0.7±0.2)mm;骨间后动脉骨皮穿支1～3支,外径(0.6±0.2)mm。二者分布尺骨中下段骨膜及相应区域的皮肤。上述穿支发皮支、筋膜支、骨膜支、皮神经—浅静脉营养血管,形成皮神经干血管链和贵要静脉旁营养血管链及深、浅筋膜和骨膜血管网。结论前臂内侧皮神经-贵要静脉营养血管与骨、皮营养血管同源,其远端蒂复合瓣的旋转轴点在腕关节平面,可用于转位修复手部远处组织缺损。

Objective To provide anatomic basis for project of distally-based compound flap pedicled with nutritional vessels of the medial cutaneous nerve of forearm.Methods We observed the origin,branches and inferior 1/3 segment of medial cutaneous nerve of forearm-basilic vein and its relationship with ulnar periosteal vessels on 30 adult cadaver superior limb specimens.Results The origin of nutritional vessels of inferior 1/3 segment of medial cutaneous nerve of forearm-basilic vein:the perforating branches of ulnar artery had(5～9)branches,diameters were(0.7±0.3)mm;diameters of dorsal carpal branches of ulnar artery were(0.7±0.2)mm.It's located in the position between 6.0～16.0cm of superior of ulnar styloid process,the bone cutaneous perforating branches of anterior artery had 2～3 branches,diameters were(0.7±0.2)mm;the bone cutaneous perforating branches of posterior interosseous artery had 1～3 branches, diameters were(0.6±0.2)mm.Conclusion The results suggest that the nutritional vessels of the medial cutaneous nerve and forearm-basilic vein and the nutritional vessels of bone and skin were homology.The rotation point of flap is close to the wrist joint,it can be applied to repair soft tissues defect of distant placeof hand.