掌短肌皮瓣的应用解剖学

Applied anatomy of the palmaris brevis musculocutaneous flap

目的：为吻合血管的掌短肌皮瓣移植提供解剖学基础。方法：３０侧灌注红色乳胶成人上肢标本，观测掌短肌的形态，肌皮瓣的血供、神经分布。结果：掌短肌呈斜方形，其桡侧长２．２±０．８ｃｍ，尺侧长２．８±０．９ｃｍ，中部宽２．８±０．６ｃｍ，中部厚２．８±０．９ｍｍ。掌短肌为尺神经浅支支配，其浅面的皮肤为尺神经浅支和尺神经的尺动脉支支配。掌短肌皮瓣的动脉血供来源有４：即尺动脉本干、掌浅支的肌皮支和皮支、掌深支和小指尺侧固有动脉的肌皮支。其静脉回流为上述动脉的伴行静脉，汇入到尺静脉，以及与手掌尺侧皮肤相连的前臂尺侧静脉。结论：以尺动、静脉为血管蒂的掌短肌皮瓣的血供来源较多，可以利用尺神经浅支和尺神经的尺动脉支形成带感觉神经的皮瓣。是修复拇指指腹大面积缺损较好的供区之一。

Objective: To provide anatomic basis for the vascularized palmaris brevis musculocutaneous falp. Methods: The shape and size of palmaris brevis muscle, the distributions of nerves and vascularis of the palmaris brevis musculocutaneous flaps were observed on 30 upper limbs which were injected with red latex.Results: The palmaris brevis muscle appeared as trapezium, its radial border was 2.2±0.8 cm long, ulnar was 2.8±0.9 cm long,its centre was 2.8±0.6 cm wide and 2.8±0.9 mm thick. The muscle was innervated by the superficial branch of ulnar nerve and the overlying skin by the superficial and arterial branches of ulnar nerve. There were four sources of blood supply to palmaris brevis musculocutaneous flap: ulnar arterial trunk, musculocutaneous and cutaneous branches of superficial palmar branch, and the musculocutaneous branches from profund branch of ulnar artery and the proper volar ulnar digital artery of little finger. The venous drainages of the flap were venae comitantes of arteries mentioned above, which converged into the ulnar vein and the vein on the ulnar side of forearm. Conclusions: The blood supply to the palmaris brevis musculocutaneous flap pedicled with ulnar vessels was rich, it could be used as a sensory flap with the superficial and arterial branches of ulnar nerve and was one of the good donor regions for repairing large pulp defects of thumb.