以前臂内侧皮神经及营养血管为蒂筋膜皮瓣的应用解剖

Applied Anatomy of Medial Forearm Fasciocutaneous Flap Pedicled Medial Forearm Cutaneous Neural Vessels

目的:为带前臂内侧皮神经及其营养血管筋膜皮瓣提供形态学基础。方法:在32侧成人上肢标本上,观测前臂内侧皮神经营养血管及其周围皮肤的供血情况。结果:前臂内侧皮神经近侧的血供来源于尺侧返动脉混合肌皮支,起始处外径为0.8mm,穿出筋膜前长度为1.1cm;中段主要来自尺动脉近中段和远中段的粗大皮支,起始处外径均为0.7mm,穿出深筋膜前长度均为1.0cm;远侧有尺动脉腕上皮支,起始处外径为0.9mm,穿出深筋膜前长为2.6cm。其神经旁血管网与神经皮(穿)支及神经内血管广泛吻合组成了皮神经血管轴。结论:可设计成带前臂内侧皮神经及营养血管为蒂筋膜皮瓣,顺行或逆行转位修复邻近部位的软组织缺损。

Objective:To provide anatomic basis for the application of medial forearm fasciocuraneous neurovascular flap. Methods: Observation and measurement of the medial foreaim cutaneous nerve and its neutrient vessels and blood supplies of its adjacent skin were made on 32 adult cadaveric upper extremity speciments. Results: The blood supply of medial forearm cutaneous nerves originated from the muscutocutaneous or septa cutaneous perforating vessels of the ulnar recurrent artery in the proximal segment of the forearm. The mean diameter was 0.8mm at its point of origin and length was 1. 1cm before perforated from deep fiscia. In the middle segment of the forearm, it came especially from a larger cutaneous branch of ulnar artery which was in the proximal middle segment and distal middle segment of the forearm,both average diameter and length were 0. 7mm and 1. 0cm, respectively before perforated from deep fiscia. However, in the distal end of the forearm, it originated from the superior carpal cutaneous branch of ulnar artery. Its average diameter was 0. 9mm and length was 2.6cm before perforated from deep fascia. A longitudinal anastomosis(chain- linked system) of intemeural fascicle and para-nerves was formed by these neutrient branches of medial forearm cutaneous neural arteries and a broad artery network in superficial fascia around the cutaneous nerves also anastomosed by the cutaneous branches and neural neutrient ones. Conclusion: The medial forearm fascioutaneous neurovascular flap(direct or adverse transfer) can be designed and used for repairing the soft tissue defects of the adjacent sites.