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背景:前臂后皮肤很适合手背侧修复,但对前臂后皮神经营养血管皮瓣的远端蒂动脉穿支缺少具体可操作性的研究,临床实际应用起来还较为困难。目的:研究前臂背侧远端的动脉穿支,为前臂后皮神经营养血管远端蒂皮瓣、复合瓣的合理设计提出解剖学理论。设计:单一样本观察。单位:解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心材料:实验于2004-05/10在解放军南京军区福州总医院军区骨科研究所临床解剖学研究中心实验室完成。研究材料为33侧动脉灌注红色乳胶成人上肢标本(由南京军区福州总医院军区骨科研究所临床解剖学研究中心提供)。方法:将33侧经成人上肢标本,以尺、桡骨茎突为观测标志点进行显微解剖。主要观察指标:①前臂背侧远端的动脉穿支。②前臂后皮神经远端的营养血管。③营养血管与邻近肌、骨、皮的血供关系。结果:①以指总伸肌为中心,前臂背侧远端的动脉穿支主要循其两侧的肌间隙和腱间隙穿出,构成远端外侧与内侧2条纵向的吻合筋膜血管丛:即前臂背外侧血管丛,以外侧肌间隙为轴线,由骨间前动脉腕背支的外侧终支、桡侧骨皮穿支、骨间后动脉的桡侧骨皮穿支和桡动脉腕背支及其穿支组成;前臂背内侧血管丛:以内侧肌间隙为轴线,由骨间前动脉腕背支的内侧终支、尺侧骨皮穿支、骨间后动脉的尺侧骨皮穿支和尺动脉腕背支及其穿支组成。②上述动脉穿支发皮支、筋膜支和前臂后皮神经营养血管,形成皮神经干血管链以及深、浅筋膜血管网。骨间后动脉的肌骨膜支分布尺骨骨膜,其桡侧骨穿皮支与桡骨中下段裸区的骨膜血管吻合,是构成远端蒂复合瓣的解剖学基础。结论:前臂背侧远端的血供具有多源性、明显纵向性和营养血管同源性的解剖学特点,可以设计3种不同供血的前臂后皮神经营养血管远端蒂皮瓣或复合瓣,旋转轴点可达腕关节平面,适宜手背远侧的组织缺损修复。
Background: The posterior forearm skin is suitable for dorsal metacarpophalangeal repair. However, the lack of specific maneuverability of the distal pedicled dorsal artery pedicel of the forearm posterior cutaneous neurovascular flap is still more difficult to be practically applied. OBJECTIVE: To study the arterial perforation at the distal dorsal forearm and to provide an anatomical theory for the rational design of the distal pedicled flap of the posterior neurocutaneous nutrient vessels. Design: Single sample observation. Unit: PLA Center for Orthopedic Research, Military Hospital of Fuzhou General Hospital of Nanjing Military Command Material: The experiment was performed at the Laboratory of Clinical Anatomy Research Center, Military Academy of Orthopedics, Fuzhou General Hospital of PLA, Nanjing Military Area Command. The study material was 33 adult arteries of the upper limbs infused with red latex (provided by the Clinical Anatomy Research Center, Military Academy of Orthopedics, Fuzhou General Hospital of Nanjing Military Region). Methods: 33 adult patients with upper extremity specimens, ulnar and radial styloid process observation points for microscopic anatomy. MAIN OUTCOME MEASURES: ① Artery perforation of distal dorsal forearm. ② forearm nerve of distal nerve nutrition. ③ nutrient vessels and adjacent muscles, bones, skin blood supply. Results: (1) With the extensor muscles as the center, the perforator of the artery distal to the dorsal forearm mainly pierced the interosseous and tendon spaces on both sides, forming two longitudinally anastomosed fascia vascular bundles: Namely the dorsal lateral forearm vascular plexus, the lateral muscle gap as the axis, the dorsal branch of the anterior interosseous artery from the lateral branch of the dorsal branch, the radial perforation of the perforation of the periosteum, posterior interosseous radial artery perforator and radial artery wrist Branch and its perforating branch; dorsal medial forearm vascular plexus: the medial muscle space as the axis, the medial branch of the dorsal branch of the anterior interosseous artery, ulnar perforation, periosteal peroneal ulnar perforation Branch and ulnar artery dorsal branch and its perforating branch. ② The above-mentioned arteries run through the branches of the dermis, the fascia and the forearm nerve of the posterior cutaneous nerve to form the vascular trunk of the dermal nerve trunk and the deep and shallow fascia vascular network. The periosteal branch of the posterior interosseous artery distributes the periosteal ulnar periosteum. The radial perforator of the peroneal bone is anastomosed with the periosteal blood vessels in the bare area of the middle and distal radius. CONCLUSIONS: The distal dorsal blood supply to the forearm possesses anatomic features of multiple sources, distinct longitudinal and nutrient vascular homology, and can design three kinds of distal pedicled neurocutaneous nutrient pedicle flap or composite flap , The axis of rotation up to the wrist plane, suitable for distal defect tissue repair.