前臂真皮下血管网皮瓣的临床解剖学研究

A clinical anatomic study on the subdermal vascular network skin flap in antebrachial region

目的研究前臂真皮下血管网构筑情况,为设计前臂真皮下血管网皮瓣提供解剖学基础。方法8侧新鲜成人上肢标本,灌注、防腐后,对前臂真皮下血管网皮瓣的血供、动脉构筑和静脉回流进行了解剖学观测。结果肱动脉末段和前臂的桡、尺动脉分别发出多达4～15支细小穿动脉,其外径在0.2～0.9mm之间。筋膜皮穿动脉入真皮下层,在真皮下层形成稠密的真皮下血管网。自此网再分支向浅面的乳头层和深面的浅筋膜层发出分支,分别构成乳头层血管网和浅筋膜血管网,这些穿支通过吻合网相互交通;真皮下静脉也相互吻合成静脉网,然后回流入深静脉。结论可根据临床需要设计成随意或轴型真皮下血管网皮瓣。设计轴型真皮下血管网皮瓣时可视蒂部的动脉外径制成转位或游离的超薄皮瓣。

Objective To investigate the vascular architecture of subdermal vascular network in antebrachial region, and provide anatomic basis for designing the subdermal vascular network skin flap in the antebrachial region. Methods Anatomical observation and measurement of the blood supply, arterial architecture and venous return of the subdermal vascular network skin flap in anterior antebrachial region were performed on 8 fresh adult specimens perfused with latex and black ink. Results It was found that 4～15 or more fine perforators derived from each the terminal end of the brachial artery and radial or ulnar arteries in anterior antebrachial region, and their diameters were between 0.2～0.9 mm. The anatomical studies showed that the fasciocutaneous perforators supplying the in anterior antebrachial region were found to form rich 'spider nevus'arterial networks on the subdermal layer. Moreover, the subdermal vascular networks were also found to give off fine arterial branches into papillary and superficial fascia layers, respectively, to form papillary vascular plexus and superficial fascia vascular network, and all of the vascular networks were anastomosed densely each other. The subdermal venous networks were also anastomosized in plexus and drained into the deep vein. Conclusion Either a random or an axial subdermal vascular network skin flap of the anterior arm can be designed according to the need of recipient defect, and the latter may also be designed as a transfer or a free subdermal vascular network skin flap according to the size of the arterial diameter in the pedicle of skin flap.