尺动脉腕上皮支降支皮瓣的解剖学基础及临床应用

Anatomy and clinical application of flaps based on the descending branch of the supracarpal cutaneous branch of ulnar artery

目的:探讨尺动脉腕上皮支降支皮瓣血管解剖学基础,总结临床应用经验。方法:5侧成人新鲜上肢标本经动脉红色乳胶灌注并解剖,观察尺动脉腕上皮支降支的起始处外径,走形距离,分支及吻合支情况。1侧成人新鲜上肢标本经氧化铅灌注,分别于灌注后2、4h行x线片摄影,观察尺动脉腕上皮支降支走形情况。临床上设计切取以尺动脉腕上皮支降支为蒂的游离皮瓣修复手部皮肤软组织缺损共计87例91块皮瓣。结果:尺动脉腕上皮支降支发出部位比较恒定,沿途分支较多,其中包括皮肤支、肌支、骨膜支,起始处外径(1.0±0.3)mm。主要营养前臂远端尺侧皮肤、腕部尺侧皮肤、手背尺侧皮肤血供。临床设计游离皮瓣87例91块修复手部软组织缺损,除1例皮瓣远端部分坏死,经二次手术植皮后愈合,其余皮瓣全部成活。术后随访6个月～3年(平均12个月),皮瓣血运、质地、弹性良好,外形美观,对供区损伤小。结论:以尺动脉腕上皮支降支为蒂的游离皮瓣修复手部创面是一种理想的方法,临床上可依具体情况选择不同的方法来修复。

Objective： To investigate the vascular anatomy of flaps based on the descending branch of the supracarpal cutaneous brach of ulnar artery with reference to its clinical application. Methods： 5 samples of fresh adult upper limbs were taken. Arterial perfusion with red latex was done before dissection to reveal the diameter, the distance of course, branches and vascular anastomosis at the beginning part of the descending branch of the supracarpal cutaneous branch of ulnar artery. X-ray photography was made for one limb sample in 2h and 4h after the infusion with lead oxide to present the course of the descending branch. Meanwhile, reconstruction surgery of soft tissue defects of the hand was performed for 87 patients, consuming 91 flaps pedicled with the descending branch of the supracarpal cutaneous branch of ulnar artery. Results： Providing the anatomically consistent outset of the descending branch of the supracarpal cutaneous branch of ulnar artery and its diverse branches （averagel.0 ±0.3mm）, including the cutaneous branch, the muscular branch and the periosteal branches, its blood supply was often more reliable than that of other branches. The diameter of the beginning part of the descending branch was found larger than that of the ascending branch, supplying the distal ulnar forearm, ulnar wrist and back ulnar skin. Survival of the 91 flaps in 87 patients was achieved except one flap that had remote partial necrosis, which healed through a second skin graft surgery. The follow-up study lasting from 6 months to 3 years （with an average of 12 months） suggested favorable flap blood circulation, texture, flexibility and aesthetic appearance with minimal damage to the donor site. Conclusions： Free flaps pedicled with the descending branch of the supracarpal cutaneous branch of ulnar artery proved to be ideal for the reconstruction of hand defects. Different approaches using these flaps are available in clinical practices to meet specific requirements.