大鱼际皮瓣血供的解剖学研究及其临床意义

An anatomic study of blood supply to greater thenar flap

目的了解大鱼际皮瓣的血供特点，为大鱼际皮瓣的合理设计提供解剖学依据。方法20侧经动脉灌注红色乳胶的成人手标本，解剖并观察大鱼际皮瓣的血供来源、走行、分支及吻合情况。结果根据拇指桡侧指动脉的来源，将大鱼际皮肤血管分为三型：Ⅰ型为掌浅支（弓）型，Ⅱ型为拇主要动脉型，Ⅲ型为交通支型。大鱼际皮瓣的血供来源主要有四个方面：①由掌浅支或其发出的拇指桡侧指动脉发出的皮支，皮支外径约0．3-1．0mm；②来源于拇主要动脉的拇指桡侧指动脉发出的皮穿支，皮支外径约0．4．0．8mm；③拇指桡侧指背动脉向大鱼际桡背侧发出的皮支；④大鱼际深部血管发出的肌皮穿支。结论四种来源的血管在大鱼际交织成网状，营养整个大鱼际皮肤，据此可设计成三种类型的带蒂皮瓣：以掌浅支（弓）发出的拇指桡侧指动脉为血管蒂的大鱼际皮瓣、拇指桡侧指动脉穿支蒂皮瓣以及大鱼际桡背侧筋膜血管蒂皮瓣。其中以拇指桡侧指动脉穿支蒂皮瓣临床应用价值最高。

Objective To understand the anatomic characteristics of the blood supply to greater thenar skin flap. Methods The origin, course, branches and anastomosis of the greater thenar vessels were observed on 20 hand specimens of adult cadaver, perfused with red gelatin into the artery. Results According to the origin of the thumb radial-palmar digital artery, the blood vessels to greater thenar skin can be divided into 3 models： the superficial palmar branch model, the thumb principal artery model, and the com- municating branch model. The blood supply to the greater thenar skin comes from： （ 1 ） the cutaneous branch coming from the superficial palmar branch of radial artery or its thumb radial-palmar digital artery, its external diameter being 0.3 to 1.0 mm; （2） the cutaneous branch coming from the thumb radial-palmar digital artery from the thumb principal artery, its external diameter being 0.4 to 0.8 mm; （3） the cutaneous branch coming from the thumb radial-dorsal artery on the radial thenar; （4） the musculocutaneous perforating branch from the deep vessel in thenar. Conclusions The vessels originating from the above 4 branches form a network to supply nutrition to the greater thenar skin. According to the anatomic characteristics of the blood supply to greater thenar skin, 3 kinds of pedicled flap can be designed： （ Ⅰ ） the thenar flap pedicled with thumb radial-palmar digital artery from the superficial palmar branch of radial artery; （2） the flap pedicled with perforating branch of thumb radial-palmar digital artery; （3） the radial-dorsal thenar fasciocutaneous flap. Of the three, the flap pedicled with perforating branch of thumb radial-palmar digital artery has the highest value in clinic application.