腕部掌侧桡动脉掌浅支横行微型皮瓣的解剖学研究

ANATOMY STUDY ON MICRO TRANSVERSE FLAP PEDICLED WITH SUPERFICAL PALMAR BRANCH OF RADIAL ARTERY FROM PALMAR WRIST

目的对腕部掌侧桡动脉掌浅支横行微型皮瓣进行解剖观测,为临床采用该皮瓣游离移植修复手指皮肤缺损提供解剖学依据。方法新鲜成人上肢标本38只,男22只,女16只;年龄26～72岁,平均36岁。左侧19只,右侧19只。各取2只标本分别制备动脉铸型标本及红色乳胶灌注标本,观察桡动脉掌浅支及其分支情况,为在龙胆紫灌注标本上显微解剖桡动脉掌浅支提供依据。34只标本于桡动脉掌浅支灌注1%龙胆紫溶液,并于腕部掌侧以远侧腕横纹为轴心线,设计一横行椭圆形皮瓣,解剖观测桡动脉掌浅支分支情况及皮肤皮下组织染色情况。结果 34只标本均存在腕部桡动脉掌浅支,距离桡骨茎突近端1.09～3.60 cm处自桡动脉主干桡侧发出后,斜向舟骨结节尺侧缘走行,其间发出2～5支皮支营养腕部掌侧皮肤。桡动脉掌浅支起始处直径为1.00～3.00 mm,舟骨结节处直径为1.00～2.90 mm。皮瓣静脉回流有桡动脉掌浅支伴行静脉及真皮下浅静脉2套系统,神经支配以正中神经掌皮支为主,皮瓣可切取范围为4 cm×2 cm～6 cm×2 cm。结论桡动脉掌浅支起始与走行恒定,直径与指动脉直径相似,可设计以桡动脉掌浅支为蒂、带正中神经掌皮支及掌长肌腱的腕部掌侧横行复合组织瓣游离移植修复手指皮肤及肌腱缺损。

Objective To study the anatomical basis of micro transverse flap pedicled with the superfical palmar branch of radial artery from the palmar wrist for using this free flap to repair soft tissue defect of the finger. Methods Thirty-eight fresh upper limb specimens （22 males and 16 females; aged 26-72 years with an average of 36 years; at left and right sides in 19 limbs respectively） were dissected and observed under operating microscope. Two specimens were made into casting mould of artery with bones, and 2 specimens were injected with red emulsion in radial artery. Thirty-four specimens were injected with 1% gentian violet solution in the superfical palmar branch of the radial artery. A transverse oval flap in the palmar wrist was designed, the axis of the flap was the distal palmar crease. The origin, distribution, and anastomosis of the superfical palmar branch of the radial artery were observed. Results The superficial palmar branch of the radial artery was constantly existed, it usually arises from the main trunk of the radial artery, 1.09-3.60 cm to proximal styloid process of radius. There were about 2-5 branches between the origin and the tubercle of scaphoid bone. The origin diameter was 1.00-3.00 mm, and the distal diameter at the styloid process of radius was 1.00-2.90 mm. The venous return of flap passed through 2 routes, and the innervations of the flap mainly from the palmar cutaneous branch of the median nerve. The area of the flap was 4 cm × 2 cm-6 cm × 2 cm. Conclusion The origin and courses of the superficial palmar branch of the radial artery is constant, and its diameter is similar to that of the digital artery. A transverse oval flap pedicled with the superfical palmar branch of radial artery in the palmar wrist can be designed to repair defects of the finger.