臂内侧皮瓣皮支血管临床解剖研究

Clinical anatomy of the medial upper arm flap pedicled with different cutaneous vessels

目的:为臂内侧皮瓣临床应用提供显微外科解剖学基础。方法:新鲜成人上肢标本18侧,经颈总动脉灌注红色乳胶,解剖观测臂内侧皮瓣血管分布情况。结果:(1)尺侧上副动脉血管径粗,行程长,适宜作为臂内侧皮瓣的蒂血管;(2)尺侧上副动脉的皮支、尺侧下副动脉皮支和肱动脉直接皮支,3组血管皮支的数目与管径呈互补关系。尺侧上副动脉无皮支发出时,可以尺侧下副动脉或肱动脉直接皮支为蒂设计皮瓣;(3)臂内侧皮瓣的皮支分布呈"人"字形,在臂内侧下部,尺侧下副动脉的皮支与肱动脉直接皮支仍然在肌间隔的前侧,并且愈向远侧愈行向前;而尺侧上副动脉及其发出的皮支位于肌间隔后侧,且愈向远侧位置愈向后。以尺侧下副动脉或肱动脉直接皮支为蒂时,皮瓣稍偏向前设计与切取;以尺侧上副动脉为血管蒂时,皮瓣稍偏向轴线的后侧设计与切取。结论:(1)臂内侧皮瓣的血管蒂,首选尺侧上副动脉;(2)当尺侧上副动脉皮支细小或没有皮支发出时,以尺侧下副动脉或肱动脉直接皮支仍然可以设计与切取皮瓣。

Objoetive： To provide anatomic basis for clinic application of the medial upper arm flap. Methods： In 18 sides of adult upper fresh specimen perfused red emulsion into common carotid artery, the distribution of blood vessels of the medial upper flap was observed. Results： （ 1 ）The superior ulnar collateral artery was the first choice as the pedicled vessel for its wide caliber and the long course. （2） There were compensatory relations among cutaneous branches of superior, inferior ulnar collateral artery and brachial artery. The cutaneous branches of the inferior ulnar collateral artery and brachial artery can be designed as the pedieled vessels if the superior ulnar collateral artery was absent. （3）Cutaneous branches of the medial upper arm flap appeared as the shape of＂人 ＂. In the inferior part of medial upper arm, cutaneous branches of inferior lunar collateral artery and brachial artery located at the front of the myoseptum, and gradually coursed anteriorly. However, the cutaneous branches of the superior collateral artery coursed at the back of the myoseptum, and gradually passed posteriorly. Therefore, the skin flap should be removed anteriorly and posteriorly when taking inferior and superior ulnar collateral arteries as the pedieled vessels respectively. Conclusions： The medial upper arm flap pedicled with superior ulnar collateral artery is desirable, otherwise, cutaneous branches of the inferior ulnar collateral artery or brachial artery can be taken as the substitutes.