以前臂内侧皮神经及营养血管为蒂的前臂内侧皮瓣的应用解剖

Applied anatomy of medial forearm fasciocutaneous flap pedicled medial forearm cutaneous neural vessels

目的 为带前臂内侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法 在 32侧成人上肢标本上 ,观测前臂内侧皮神经营养血管及其周围皮肤的血供情况。结果 前臂内侧皮神经近侧的血供来源于尺侧返动脉混合肌皮支 ,起始处外径为 0 .8mm ,穿出深筋膜前长度为 1.1cm ;中部主要来自尺动脉近中段和远中段的粗大皮支 ,起始处外径均为 0 .7mm ,穿出深筋膜前长度均为 1.0cm ;远侧有尺动脉腕上皮支 ,起始处外径为 0 .9mm ,穿出深筋膜前长度均为 1.0cm ;远侧有尺动脉腕上皮支 ,起始处外径为 0 .9mm ,穿出深筋膜前长为 2 .6cm。其神经旁血管网与神经皮穿支及神经内血管广泛吻合组成了皮神经血管轴。结论 可设计成带前臂内侧皮神经及营养血管为蒂筋膜上瓣 ,顺行或逆行转位修复邻近部位的软组织缺损。

Objective To provide anatomic basis for the apply of medial forearm fasciocutaneous neurovascular flap.Methods The observaiton and measurement of the medial forearm cutaneous nerve and its neutrient vessels and blood supplise of its adjacent skin were made on 32 adult cadaver upper extremity specimens.Results The blood supply of medial forearm cutaneous nerves origins from the muscutocutaneous or septa cutaneous perforating vessels of the ulnar recurrent artery in the proximal segment of the forearm.The mean diameter is 0.8mm at its point of origin and length is 1.1cm before perforated from deep fascia.In the middle segment of the forcarm,it comes respeetivcly from a larger cutancous branch of ulnar artcry which is in proximal middle segment and in distal middle segment of the forearm,both average diameter and length are 0.7mm and 1.0cm,separately before perforated from deep fascia.However,in the distal end of the forearm,it origins from the superior carpal cutaneous branch of ulnar artery.Its average diameter is 0.9mm and length is 2.6cm before perforated from deep fascia. A longitudinal anastomosis(chainlinked system)of interneural fascicle and para nerves was formed by these neutrient branches of medial forearm cutaneous neural arteries and a broad artery network in superficial fascia around the cutaneous nerves also anastomosed by the cutaneous branches and neural nutrient ones each other.Conclusions The medial forearm fasciocutaneous neurovascular flap(direct or adverse transfer)could be designed and used for repairing the soft tissue defects of the adjacent sites.