前臂内侧神经血管复合体岛状筋膜皮瓣的应用解剖

Applied Anatomy of the Island Fasciocutaneous Flap Pedicled With the Neurovascular Territories of the Anteromedial View of Forearm

目的为前臂内侧神经血管复合体岛状筋膜皮瓣的应用提供解剖学基础。方法上肢标本18侧,显微剥离表皮组织,观察前臂内侧皮神经、贵要静脉及各自营养血管的起始、走行、分支、分布及与其它血管的吻合情况;新鲜整尸标本5具,动脉灌注显影剂,剥离体被组织于X光下摄影,分析皮动脉的分布及其与毗邻血管的关系。结果前臂内侧皮神经前支与贵要静脉伴行,两者周围分布着外径大于0.5 mm的营养动脉,平均3.4支,它们分别来自尺侧下副动脉、尺侧返动脉和尺动脉,营养动脉彼此吻合,形成动脉血管链。其中第一支位于肘横纹上21.25±6.33 mm,血管外径1.03±0.24 mm。结论可以在前臂内侧部切取神经血管复合体岛状筋膜皮瓣,供临床使用。

Objective To provide the anatomical basis for the island fasciocutaneous flap pedicled with the neurovascular territories of the anteromedial view of the forearm. Methods In 18 adult upper extremity cadavers, origins, courses, branches, distribution and the anastomosis of the medial antebrachial cutaneous nerve, basilic vein and their nutrient vessels were studied under the operating microscope. 5 fresh adult cadavers, photographic developer were injected in the artery. Integument was stripped and x- rayed; the superficial arteries were studied on the angiogram. Results Anterior branch of the medial antebrachial cutaneous nerve accompanied with the basilic vein, distributed on the anteromedial surface of the forearm. There were many nutrient vessels were seen around. In average, there were 3.4 branches appeared which were bigger than 0.5 mm in the diameter. The nutrient vessels came from the inferior ulnar collateral artery, the ulnar recurrent artery, and the ulnar artery. The first one emerged at 21.25 ± 6.33 mm above the transverse line of the elbow, the diameter was 1.03 ± 0.24 mm. The nutrient vessels anastomose with each other and formed the vessel chain. Conclusion The island faciocutaneous flap pedicled with the neurovascular territories of the anteromedial view of the forearm can be used in clinical.