前臂后外侧穿支皮瓣游离移植修复手指中、大面积皮肤缺损的解剖学研究

Anatomy study of using posterior-lateral forearm free perforator flap to repair skin defects in the finger

目的介绍前臂后外侧穿支皮瓣游离移植修复手指中、大面积皮肤缺损的应用解剖学基础。方法对36例成人尸体上肢标本,手术显微镜下进行前臂后外侧局部解剖,观测前臂后外侧皮肤的营养动脉、回流静脉、神经支配来源。结果自桡骨lister结节至肱骨外侧髁连线中点附近指伸肌和桡侧腕伸肌肌间隔内有一恒定的皮支动脉营养前臂后外侧皮肤,该动脉有两条伴行静脉,神经支配为前臂后侧皮神经分支,游离移植可切取血管蒂长度为(4.12±0.26) cm,血管起始处外径为(0.91±0.07) mm,是与指动脉口径相仿的穿支皮瓣。结论前臂后外侧皮肤可制成以桡骨lister结节至肱骨外侧髁连线中点附近的指伸肌和桡侧腕伸肌肌间隔皮肤动脉穿支为蒂的游离穿支皮瓣移植修复手指皮肤缺损。

Objective To study the anatomical basis of using posterior-lateral forearm free perforator flap to repair soft tissue defects in the finger. Methods Thirty six upper limb specimens were dissected . The origin, distribution and anastomosis of the vessels, nerves in the posterior-lateral forearm were oberserved with regional anatomy using surgical magnifying glass. Results At the midpoint of line from the radial lister nodule and the humeral condyle , between the septum of extensor digitorum muscle and extensor carpi radialis muscle, there was a intermuscular septum cutaneous perforator which constantly existed with two accompanying veins. The posterior antebrachial cutaneous nerve innervated this area. The length of artery pedicle was 4.12±0.26 cm, and the diameter was 0.91±0.07mm at the origin, which was similar to the digital artery. Conclusion The traditional skin donor site from the posterior-lateral forearm can be applied as a free flap pedicled by the intermuscular septum cutaneous perforator artery to repair soft tissue defects in the finger.