掌深弓手背穿支皮瓣的解剖学基础

Anatomical basis of the flap based on the perforator of the deep palmar arch

目的探讨掌深弓手背穿支形态学特征，为穿支蒂V．Y推进皮瓣设计提供解剖学基础。方法选用31侧成人手标本，30侧经甲醛防腐固定、动脉内灌注红色乳胶，手术放大镜下重点解剖观测：①掌深弓手背穿支的起源、走行、分支与分布；②掌深弓手背穿支与腕背、掌背血管网的吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。结果掌深弓手背穿支共有3支，穿过第2～4骨间背侧肌两头间至手背分为升、降2支，升支与腕背网吻合，降支延续为2—4掌背动脉。掌深弓第1～3手背穿支起始外径分别为（1．1±0．2）mm、（0．9±0．3）mm、（0．7±0．1）mm，干长分别为（1．1±0．3）cm、（1．0±0．2）cm、（0．9±0．1）cm。结论以掌深弓手背穿支为蒂，可形成V—Y推进皮瓣修复掌背或腕背部软组织缺损。

Objective To investigate the morphological characters of the dorsal perforators originated from the deep palmar arch, so as to provide anatomic basis for V-Y advanced perforator flap. Methods The following contents were investigated in 30 adult hand specimens perfused with red latex under surgical magnifier： （1） The origin, courses, branches and distribution of the dorsal perforators originatedd from the deep palmar arch. （2）The characters of anastomosis among the dorsal perforators, the dorsal carpal and metacarpal arteries. Mimic operation was performed on another fresh specimens perfused with red latex. Results There were three perforators originated from the deep palmar arch, which passed through the 2nd -4th dorsal interossei and then divided into an ascending branch and a descending branch at the dorsum of hand. Then the ascending branch anastomosed with the dorsal carpal artery, and the descending branch stretched to the 2nd -4th dorsal metacarpal arteries. The originating outer diameters of the lst-3rd perforators were （1.1 ±0.2） mm, （0.9 ±0.3） mm and （0.7 ±0.1） mm respectively, and the length of the stems were （1. 1 ±0. 3） cm, （1. 0 ±0. 2）cm and （0. 9 ±0. 1） cm respectively. Conclusions The V-Y advanced perforator flap with the dorsal perforator of the deep palmar arch as its vascular pedicle could be used to repair the dorsal carpal or dorsal metacarpal soft tissue defects.