尺动脉近段穿支蒂皮神经营养血管皮瓣的解剖基础

Anatomic basis of the proximal ulnar artery perforator neurocutaneous flap

目的为尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣提供解剖学基础。方法在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观测:①前臂内侧皮神经的走行与分布;②尺动脉近段穿支与前臂内侧皮神经营养血管间吻合关系。另在1侧新鲜标本上进行摹拟手术设计。结果①前臂内侧皮神经前支较粗长,与贵要静脉伴行,在前臂沿尺侧腕屈肌内侧缘或尺侧腕屈肌与掌长肌肌腱之间的浅筋膜中下行,分布于前臂掌面尺侧,远侧可达腕横纹;②营养血管为多节段、多源性,其中尺动脉近段穿支的位置相对恒定,自尺动脉起始后,先经指浅、深屈肌之间,后沿指浅屈肌与尺侧腕屈肌之间下行,在肱骨内上髁下8.7 cm处穿过深筋膜浅出至皮下组织中,并分出众多的细小血管与前臂内侧皮神经的神经旁和神经干血管链的分支密切吻合,在指浅屈肌与尺侧腕屈肌之间形成顺沿肌间隙和前臂内侧皮神经纵轴的血管丛。穿支蒂干长(2.0±0.2)cm,外径(0.9±0.2)mm。结论可形成尺动脉近段穿支蒂前臂内侧皮神经营养血管皮瓣转位修复肘部软组织缺损。

Objective To provide anatomic basis for clinical application of the neurocutaneous flap pedicled with proximal ulnar artery perforator.Methods 30 embalmed upper limbs from adult cadavers perfused with red latex were used for this anatomic study,and the followings were observed： ①The course and distribution of the medial forearm cutaneous nerve.②Aanastomoses between the proximal ulnar artery perforator and nutrient vessels of medial forearm cutaneous nerve.③Mimic operation was performed on one fresh specimen.Results ① Anterior branch of the medial forearm cutaneous nerve（MFCN）,with the relative large diameter,companied with basilic vein and coursed through superficial fascia located in flexor carpi ulnaris and palmaris longus.The MFCN distributed on medial forearm and distally reached transverse striation of the wrist.②The nutrient vessels of MFCN were plurisegmental and polyphyletic.The proximal ulnar artery perforator is more constant,originated from ulnar artery,passed through flexor digitorum superficialis and flexor digitorum profundus,coursed down between flexor digitorum superficialis and flexor carpi ulnaris,and left deep fascia into subcutaneous tissue below the internal epicondyle of humerus about 8.7cm.And then proximal ulnar artery perforator gave off many small vessels,which anastomised with those nutrient vessels of medial forearm cutaneous nerve,and formed a vascular plexus followed with medial forearm cutaneous nerve between flexor digitorum superficialis and flexor carpi ulnaris.The proximal ulnar artery perforator was about（2.0±0.2） cm in length,and（0.9±0.2） mm in the diameter.Conclusions The proximal ulnar artery perforator neurocutaneous flap can be performed to repair defects around elbow joint.