腕部掌侧带血供皮瓣游离移植修复手指皮肤缺损的应用解剖研究

Applied anatomy study of vascularized flap from the volar aspect of the wrist to repair soft tissue defects in the finger

目的介绍腕部掌侧皮肤带血供游离移植修复手指皮肤缺损的应用解剖学基础。方法解剖观测20例成人尸体上肢标本,2例标本做带骨骼动脉铸型,18例标本做肱动脉乳胶灌注。在手术显微镜下进行解剖,观测腕部掌侧皮肤的营养动脉、回流静脉、神经支配来源、其内的掌长肌腱。结果腕部掌侧皮肤主要由桡动脉掌浅支分支营养,静脉回流有深浅两种途径,神经支配以正中神经掌皮支为主,桡神经浅支为辅,游离移植可切取面积为2cm×4cm^2 cm×5cm[2cm×(4.42±0.58)cm]。桡动脉掌浅支起始处直径为(1.25±0.24)mm,与指动脉直径相仿。结论传统的腕部掌侧供皮区皮肤可以形成以桡动脉掌浅支为蒂的复合组织皮瓣游离移植修复手指的皮肤缺损。

Objoetivo To study the anatomical basis ofvascularized flap from the volar aspect of the wrist to repair soft tissue defects in the finger. Mothods Twenty upper limb specimens were dissected and observed under operating microscope. Two specimens were made into casting mould of artery with bones, Eighteen specimens were injected with red latex in radial artery. The origin, distribution and anastomosis of the vessels, nerves and tendens in the volar aspect of the wrist were oberserved. Results The superficial palmar branch of the radial artery constantly existed, and it was the main nutrient vessel of the wrist volar skin. There were about 2 to 5 branches between the origin and the tubercle of the scaphoid bone. The diameter was （1.25_＋ 0.24） mm at the origin, which was similar to the digital arteries .The venous re^n＇n of wrist volar skin passed through two routes, and the innervations of the wrist volar skin derived mainly from the palmar cutaneous branch of the median nerve.The area of the flap with blood supply from the volar aspect of the wrist was 2cmx （4.42±0.58）cm. Conelia The traditional skin donor site from the volar aspect of the wrist can be applied as a free composite tissue flap pedicled by the superficial palmar branch of the radial artery to repair soft tissue defects in the finger.