同指带神经血管蒂顺行岛状皮瓣的应用解剖

Applied anatomy of antegrade neurovascular island flap from the same finger

目的探讨同指带神经血管蒂顺行岛状皮瓣的显微解剖结构，为修复指端软组织缺损提供解剖学依据。方法解剖20侧成人尸体手标本，解剖观察皮瓣的神经血管束结构及皮瓣的推进距离。结果皮瓣推进距离拇指为（16．7±1．4）mm，示指为（18．5±1．2）mm，中指为（19．7±1．8）mm，环指为（18．1±1．0）mm，小指为（15．8±1．2）mm；该皮瓣能前移1．5～2．0cm左右，掌指关节和指间关节屈曲15°～20°，可增加约0．5cm左右，皮瓣最大推进距离以2．0—2．5cm为宜。结论同指带神经血管蒂顺行岛状皮瓣操作简便，兼顾外观、感觉及功能，是修复指腹创面的理想皮瓣。

Objective To investigate the micro-anatomical structures of the antegrade neurovascular island flap and provide anatomical basis of using this flap from the same finger for repairing finger pulp defects. Methods Twenty adult cadaver hand specimens were dissected under a surgical microscope. Anatomical structures of the neurovascular bundle of the flap were observed and the flap advancing distance was measured. Results The advancing distance of the island flap was （16.7 ± 1.4） mm in the thumb, （18.5 ± 1.2） mm in the index finger, （ 19.7 ± 1.8） mm in the middle finger, （ 18.1 ± 1.0） mm in the ring finger and （ 15.8 ± 1.2） mm in the little finger. Overall the flap could be advanced about 1.5 to 2.0 era. Another 0.5 cm advancement could be achieved when the metacarpophalangeal joint and proximal interphalangeal joint were flexed for 15° to 20°. The maximum advancing distance should not exceed 2.0 to 2.5 cm. Conclusion Advancement of antegrade neurovascular island flap from the same finger offers a sensate skin flap for coverage of finger pulp defect. The surgical technique is simple, and the clinical results are satisfactory. It is an ideal method for reconstruction of thumb or finger pulp defects.