带感觉神经的小指尺侧指动脉穿支皮瓣的显微解剖及临床应用

Anatomical study and clinical application of the sensory perforator flap from the ulnar palmar digtal artery of the little finger

目的 探讨带感觉神经的小指尺侧指动脉穿支皮瓣的解剖学基础及移植修复手指指腹皮肤软组织缺损的疗效.方法 选择6具新鲜尸体,用红色乳胶灌注上肢,对12侧小鱼际区进行解剖研究,观察小指尺侧指动脉穿支皮瓣的血管神经的解剖结构特点.2013年9月至2015年1 1月,采用带感觉神经的小指尺侧指动脉穿支皮瓣,移植修复13例手指指腹皮肤软组织缺损,供区直接拉拢缝合.结果 解剖学研究发现,小指尺侧指动脉在小鱼际区发出恒定的穿支营养皮肤,小指尺侧指神经在该区也有恒定的分支支配皮肤感觉,小指尺侧指动脉管径约为1.28 mm,适于显微吻合.术后13例皮瓣全部成活,随访3 ～15个月,皮瓣外观良好,感觉恢复S3,两点辨距觉为8～9 mm,手指活动良好,小指感觉无明显减退,小鱼际区只留下一条线性瘢痕,无明显不适.结论 根据小指尺侧指动脉在小鱼际区的穿支,和小指尺侧指神经在该区的分支,可以制备带感觉神经的小指尺侧指动脉穿支皮瓣,是修复手指指腹皮肤软组织缺损的较好选择.

Objective To study the anatomical basis of the sensory perforator flap from the ulnar palmar digtal artery of the little finger and its application in reconstruction of soft tissue defect on the finger pulp.Methods The origins and distributions of the blood vessels and nerves of the hypothenar region were observed in 6 fresh cadavers whose upper limbs were perfused with red latex.From September 2013 to November 2015,13 cases with soft tissue defects on the finger pulp were treated.All patients received the sensory perforator flap from the ulnar palmar digtal artery of the little finger.The donor site was sutured directly.Results Through anatomical study,we found that the ulnar palmar digital artery of the little finger gives off constant cutaneous perforarter to nourish the skin of the hypothenar region,so do the ulnar palmar digital nerve of the little finger.The diameter of the artey is about 1.28 mm and suitable for microvascular anastomosis.All the 13 flaps survived.The patients were followed up for 3 months to 15 months.All the flaps had a good appearance.The sensation of the flaps recovered to S3 and two-point discrimination was 8-9 mmm.All the fingers had good function.There was only one linear scar on the hypothenar region without any discomfort.Conclusions The ulnar palm digital artery of the little finger contains constant branches to nourish the skin of the hypothenar region,so do the ulnar palrnar digital nerve of the little finger.So we can design a flap with sensory nerve on the hypothenar region.It is an effective method to repair soft tissue defect of the finger pulp with the free sensory perforator flap from the ulnar palmar digtal artery of the little finger.