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背景: 前臂后皮神经营养血管皮瓣适合手背侧修复, 然而对于其远端蒂复合皮瓣的系统解剖学特点有待深入研究。目的: 对前臂后皮神经营养血管皮瓣进行观察, 探讨低旋转点的前臂后皮神经营养血管远端蒂皮瓣和复合瓣的解剖学特点。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2004-10/12 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 30 侧动脉灌注红色乳胶成人上肢标本( 由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提供) 。方法: 将成人上肢标本以尺、桡骨茎突为观测标志点进行显微解剖。重点解剖: 前臂后皮神经营养血管的来源、分支及吻合; 前臂后皮神经营养血管与邻近骨、皮的血供关系。主要观察指标: 前臂后皮神经营养血管的来源、分支、吻合及其与邻近骨、皮的血供关系。结果: 前臂后皮神经营养血管, 近端来自桡侧副动脉穿皮支 2～6 支, 外径(0.6±0.3) mm; 远端来自骨间前动脉腕背支穿皮支 3～5 支, 外径(0.8±0.2) mm; 其他来自骨间后动脉穿皮支 6～9 支, 外径(0.7±0.3) mm。骨间后动脉发外径 0.3～1.0 mm 的肌骨膜支 6～8 支, 分布尺骨骨膜; 骨间后动脉的桡侧骨穿皮支与桡骨中下段裸区的骨膜血管吻合。上述支发出穿皮支、筋膜支、骨膜支和神经营养血管支, 形成皮神经干血管链以及深、浅筋膜和骨膜血管网。结论: 前臂后皮神经营养血管与邻近骨、皮营养血管同源, 其远端蒂皮瓣、复合瓣的旋转轴点可达腕关节平面, 适宜手背远处的组织缺损的移植修复。
Background: The forearm posterior cutaneous nerve nutrient vessel flap is suitable for dorsal hand repair. However, the anatomic features of the distal pedicle flap need further study. OBJECTIVE: To observe the anatomical features of the pedicled neurocutaneous flap of the posterior subclavian nerve and to explore the anatomic features of the distal pedicled dural flap and composite flap of the posterior branch of the posterior cutaneous nerve nutrient vessel with low rotation point. Design: Single sample observation. Unit: PLA Military Hospital, Fuzhou General Hospital of Military Orthopedic Research Clinical Anatomy Research Center. MATERIALS: The experiment was performed in the laboratory of Clinical Anatomy Research Center of Military Academy of Orthopedics, Fuzhou General Hospital of PLA, Nanjing Military Area Command from October to October 2004. The study materials were 30 adult arteries of the adult with upper limbs infused with red latex (provided by the Clinical Anatomy Research Center of the Military Academy of Orthopedics, Fuzhou General Hospital of PLA, Nanjing Military Area Command). Methods: The adult upper limb specimens were examined by microsurgical and microscopic anatomy with ulna and radius styloid. Key anatomy: the origin, branch and anastomosis of the nutrient vessels in the posterior branch of the posterior cutaneous nerve; the relationship between the blood supply of the nutrient vessels in the posterior branch of the posterior cutaneous nerve and the adjacent bone and skin. MAIN OUTCOME MEASURES: The origin, branch, anastomosis and its relationship with the blood supply of the adjacent bones and bones in the forearm posterior cutaneous nerve nutrient vessels. Results: The forearm posterior cutaneous nerve nutrient vessels, the proximal radial artery from the percutaneous branches 2 to 6, diameter (0.6 ± 0.3) mm; distal from the anterior intercarpal artery dorsal ramus through the branching 3 to 5 , Outer diameter (0.8 ± 0.2) mm; other from the interosseous artery perforating branches 6 ~ 9, diameter (0.7 ± 0.3) mm. Posterior interosseous artery of 0.3 ~ 1.0 mm in diameter of the periosteal branch of 6 to 8, the distribution of periosteal periosteum; posterior interosseous artery radial dermoid perforator and the radial section of the proximal periosteal vascular anastomosis. The branch out through the skin branch, fascia, periosteum and neurotrophic vascular branches, the formation of the dermal nerve trunk vascular chain and deep, superficial fascia and periosteal vascular network. CONCLUSION: The nutrient vessels in the posterior branch of the posterior cutaneous nerve are homologous with the nutrient vessels of the adjacent bones and skins. The distal axis of the pedicle flap and the compound flap can reach the level of the wrist joint. It is suitable for the transplantation and repair of the tissue defects in the distant back of the hand.