指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖

Applied anatomy of the dorsal metacarpal and digital fasciocutaneous flap pedicled with the dorsal cutaneous branch of the proper digital artery

目的为指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣提供系统翔实的解剖学依据。方法14只新鲜成人尸体手标本,灌注红色乳胶,手术显微镜下解剖观测手背和2～5指指背血管的走行、分布、吻合情况及外径。结果手指近、中节每侧各有1～7支间接背侧皮支,2～8支背侧皮支。手指近节中段、近节远段、中节近段或中段每侧较为恒定的存在一支较粗大的指固有动脉背侧皮支,皮支平均外径通常≥0.30mm。掌背动脉终末段和远端掌深弓穿支的指背分支在近节指背与指固有动脉背侧皮支交通。不同节段指固有动脉背侧皮支在指背外侧缘交互吻合,在指背外侧缘形成一条营养血管链。结论以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣解剖简单、快捷,旋转弧长,利于修复手指中远节较大面积的软组织缺损。

Objective To provide applied anatomic evidences for the application of the dorsal metacarpal and digital fasciocutaneous flap pedicled with the dorsal cutaneous branch of the proper digital artery.Methods 14 fresh adult cadaveric hands were injected with red latex.The dorsal digital and metacarpal vessels of the cadaveric hands were dissected layer by layer,and their course,distribution,connection and external diameter were observed and measured with the aid of an operating microscope.Results There were 1 to 7 indirect dorsal cutaneous branches and 2 to 8 direct dorsal cutaneous branches of the proper digital artery in each side of proximal and middle phalanx,respectively.There was a relatively large dorsal cutaneous branch of the digital artery in each side of the middle and distal third of the proximal phalanx,the proximal or middle third of the second phalanx,respectively,whose external diameters were more than 0.3 mm usually.The dorsal digital branches of the terminal segment of dorsal metacarpal artery and distal dorsal perforator of deep palmar arch anastomosed with the dorsal cutaneous branches of the digital artery.The dorsal cutaneous branches of the digital artery in different segments anastomosed with each other at the dorsolateral aspect of phalanx,where a arterial link was formed.Conclusions The reverse dorsal metacarpal and digital fasciocutaneous flap pedicled with the dorsal cutaneous branch of the proper digital artery is more suitable for repairing comparatively large-area soft tissue defects of middle and distal phalanx,for their advantages of easy and secure harvest,and the longer arch of rotation.