示指背侧矩形皮瓣切取的显微解剖与临床应用

Anatomy study and clinical application of rectangular flap from dorsal index finger based on the first dorsal metacarpal artery

目的通过对第1掌背动脉及指固有动脉背侧支的解剖学观察，总结第1掌背动脉及指固有动脉背侧支走行及分支吻合规律，探讨示指背侧矩形皮瓣修复拇指末节套状撕脱伤的手术方法和临床效果。方法2006年2月-2014年2月，用6只新鲜成人手标本，经天然乳胶灌注，显微解剖观察第1掌背动脉终末支及指固有动脉背侧支走行及分支吻合规律和特点：以第1掌背动脉供血，切取示指近中节背侧矩形皮瓣。修复拇指末节套状撕脱伤皮肤缺损21例，并吻合指固有神经背侧支重建指腹感觉。皮瓣切取面积最大3．2cm×4．3cm，最小4．8cm×2．5cm。供区于腹股沟区切取全厚皮片游离移植。结果解剖发现第1掌背动脉于拇长伸肌腱与第2掌骨基底交叉部由桡动脉发出，沿第2掌骨桡侧缘下行，终末皮支沿示指掌指关节桡背侧缘向远端走行，与示指桡侧指固有动脉近节近端背侧支的上行支吻合。21例皮瓣全部成活，随访6～35个月，平均17．4个月。拇指功能及外观恢复满意，指腹感觉恢复s，＋，两点辨别觉恢复6-11mm，平均8．6mm，供区无瘢痕挛缩、肌腱粘连及感觉障碍等并发症。结论第1掌背动脉与示指桡侧固有动脉近节背侧支吻合，示指近节、中节背侧支间相互吻合成指侧方血管链及指背血管网。改良示指背侧矩形皮瓣修复拇指末节脱套伤，吻合指固有神经背侧支重建指腹感觉，是修复拇指末节脱套伤较为理想的方法。

Objective To dissect and measure the first dorsal metacarpal artery and the dorsal branch of proper digital artery in fresh hand specimens, and explore the therapeutic effect of rectangle flap from dorsal index finger to repair avulsed thumb injury, and to discuss the operation and outcome of the flap for tissue defect of thumb. Methods From February, 2006 to February, 2014, the first dorsal metacarpal artery and the dorsal branch of proper digital artery from 6 fresh adult hand specimens perfused by red latex were explored. Twenty-one thumbs with skin defect in degloving injury patients were treated with rectangle flap from index finger based on the first dorsal metacarpal artery. And the dorsal branch of index finger proper nerver was anastomosed to reconstruct the feel of pulp of thumb finger. The size of the flaps ranged from 3.2 cm ×4.3 cm to 4.8 cm ×2.5 cm. The donor was covered by skin graft from groin. Results The first dorsal metacarpal artery originated from the radial artery between the second metacarpal and the extensor pollieis longus. The distal branch of the first dorsal metacarpal artery anastomosed with the dorsal branches of the proper artery of index finger. All flaps survived and were followed up for 6-35 months,an average of 17.4 months. The function of the thumb was well. And the thumb restored satis- factory appearance, restored the S3＋ pulp feeling. Two-point discrimination restored 6-11 mm （average, 8.6 mm）. There was no scar contracture,tendon adhesion and complications such as sensory disturbance in donor area. Conclusion The first dorsal metacarpal artery anastomosed with the dorsal branch of the proper artery of proximal index finger. The dorsal branches of proper artery in proximal and middle segments of index finger composed of the dorsal vessel network. Repairing soft tissue of thumb with dorsal rectangle flap of index finger based on the first dorsal metacarpal artery is recommendable .It can be easily and conveniently performed.