以足底内侧动脉深支内侧支为蒂游离足内侧皮瓣的应用解剖

目的 :为以足底内侧动脉深支的内侧支为蒂足内侧皮瓣设计的改进提供解剖学基础。方法 :在 32侧成人下肢标本及 2只灌注红色乳胶成人新鲜足标本 ,解剖观测了足底内侧动脉深支的内侧支分支分布、吻合、外径及长度 ,皮瓣的静脉和神经分布。结果 :内侧支长 (2 .6± 0 .2 )cm ,外径 (1.0± 0 .1)mm ;伴行静脉 1条占 75 % ,外径 (1.3± 0 .3)mm ,伴行静脉 2条者占 2 5 % ,外径 (0 .9± 0 .2 )mm ;皮瓣供区有隐神经终支和足背内侧皮神经内侧支分布。结论 :①足内侧皮瓣可以是足底内侧动脉深皮内侧支或由跗内侧动脉供血 ;②静脉为动脉伴行静脉和大隐静脉深、浅两套 ;③皮瓣有隐神经终支和足背内侧皮神经内侧支 ;④游离足内侧皮瓣适用于手部创面修复的特殊要求。     

胫前动脉踝上皮支皮瓣的显微外科解剖

目的 :报道胫前动脉踝上皮支皮瓣的显微外科解剖学基础。方法 :在 14侧经动脉灌注红色乳胶成人下肢标本 ,解剖观测胫前动脉踝上皮支的起始、走行、外径、长度及分支等 ,2侧成人下肢标本灌注墨汁观察该皮支的墨染范围。结果 :胫前动脉踝上皮支于踝间连线上方 ( 3 .5± 0 .6)cm自胫前动脉发出 ,然后向小腿内侧方向绕过胫骨前缘分出升支和降支 ,升支紧贴胫骨前内侧骨面 ,向内上方向行至一段距离后穿深筋膜入皮。踝上皮支长 ( 2 .1± 0 .6)cm ,起点外径 ( 1.1± 0 .2 )mm ,伴行静脉 2条。升支入筋膜前外径 ( 0 .4± 0 .1)mm。降支向内下方向走行 ,并与踝前血管网吻合。结论 :胫前动脉踝上皮支是胫前动脉在小腿踝上部的主要皮血管 ,分支营养骨膜 ,可在小腿中下段设计以此血管为蒂的皮瓣、骨膜瓣、骨膜皮瓣或骨皮瓣。     

指背血管蒂岛状皮瓣应用解剖

目的:为指背血管蒂岛状皮瓣提供解剖学依据。方法:10具尸体20只手逐层解剖观察手背侧动脉、静脉、神经走行方向及分布。结果:拇指尺侧指背动脉起点外径为(0.37±0.05)mm,示指桡侧指背动脉的起点外径为(0.40±0.07)mm,示指尺侧、中指两侧、环指两侧、小指桡侧指背动脉的起点外径为(0.32±0.06)mm,1～5指两侧指背静脉于近侧指间关节处外径为(0.51±0.07)mm。平掌指关节处拇指尺侧指背神经横径为(0.41±0.06)mm;示指桡侧指背神经横径为(0.38±0.07)mm。结论:以指背血管为蒂的岛状皮瓣,血管走行恒定,血运丰富,是修复手指邻近创面的理想皮瓣。     

背阔肌皮瓣的血管和神经供给

解剖了50具成年尸体,对背阔肌皮瓣的形态、大小、血管和神经进行了观察和测量。肩胛下动脉的长度为23.8±1.2mm,外径为3.7±0.2mm。胸背动脉的长度为92.2±1.9mm,外径为2.3±0.1mm。胸背神经的干长为75.9±1.9mm,外径为2.0±0.1mm。主要神经血管门约位于腋后襞下方10cm,背阔肌前缘后方2cm,相当于肩胛骨下角平面处。整个背阔肌表面的皮肤,除了肩胛骨下角平面稍上方的皮肤外,均可作为肌皮瓣提取。对背阔肌皮瓣、肌骨皮瓣和反转的岛状感觉肌皮瓣的临床应用作了讨论。     

带血管蒂面颊部皮瓣移位修复鼻尖部缺损的应用解剖

目的:为带血管蒂面颊部皮瓣修复鼻尖部缺损提供解剖学基础。方法:15例动脉内注红色乳胶的头颈部标本,解剖双侧面动脉发出至口角外上方、颧弓下方颊区内的直接皮支,测量皮支的外径、长度。将两侧口角连线的延长线定义为横线,眶上孔和颏孔中点连线定义为垂线,分别测量皮支起点与两者间的距离,以此定位皮支起点的体表投影。1例铸型标本以观察面动脉直接皮支的起点和与其他动脉的吻合情况。结果:面动脉发出上唇动脉后,由其后壁向上发出1支至颊部的皮动脉,出现率86.7%。皮支起始处外径为(0.98±0.20)mm,长度为(1.40±0.54)cm。皮支起点的投影位于横线上方者占76%,与横线的垂直距离为(0.65±0.22)cm;皮支起点的投影均位于垂线外侧,与垂线的水平距离为(2.64±0.82)cm。结论:带血管蒂面颊部皮瓣转移经临床证实是修复或再造鼻尖部缺损的良好供区。     

隐动脉膝上皮支逆行筋膜皮瓣的解剖及临床应用

目的 :为隐动脉膝上皮支逆行筋膜皮瓣提供解剖学基础。方法 :对 2 0侧新鲜成人下肢标本用红色乳胶液加压灌注 ,在 5倍手术放大镜下观测隐动脉及其皮支的起始、走行、外径、供血范围及其与缝匠肌的关系 ,设计隐动脉膝上皮支逆行筋膜皮瓣。结果 :隐动脉于收肌结节上方 (2 .6 9± 1.0 9)cm处发出恒定的膝上皮支 ,外径 (1.10±0 .18)mm ,有两条伴行静脉 ,外径 (1.12± 0 .10 )mm。该支于收肌结节上方 (1.4 8± 0 .5 3)cm处穿深筋膜后分为上行支及下行支。下行支长度为 (2 .91± 1.0 1)cm ;上行支直接行经 (4 .39± 1.0 9)cm ,末端与隐动脉近侧穿支、肌皮支形成网状联系。结论 :隐动脉膝上皮支起始位置恒定 ,口径较粗 ,以收肌结节上 1.5cm处为皮瓣旋转点 ,以股内侧中下段为供区 ,可设计隐动脉膝上皮支逆行筋膜皮瓣用于修复膝周软组织缺损。     

腹股沟三角的应用解剖学及其临床意义

目的　为解剖学和临床应用提供解剖学资料。方法　采用成人尸体标本 5 1具 (男 4 1,女10 )、10 1侧 ,解剖、观察腹沟韧带 ,腹直肌外侧缘 ,腹壁下动脉起点、行程和闭孔支。测量腹壁下动脉起端外径和腹股沟三角 (Hesselbach’sTriangle)的境界。 结果　腹股沟三角的a -b间距男、女性分别为 5 .4 3± 1.2 9cm和 4 .99± 1.2 3cm ;b -c间距分别为 6 .98± 1.35cm和 6 2 5± 1 0cm ;c -a间距分别为 5 0 3± 0 73cm和 4 82± 0 5 9cm。男、女合计 ,a -b ,b -c和c -a间距分别为 5 35± 1 3cm ,6 84± 1 34cm和 4 99±0 71cm。腹壁下动脉起端外径为 0 2 4± 0 0 4cm ,起点在腹股沟韧带平面以上者占 5 9 4 1% ,平均距腹股沟韧带上 1 0 6± 0 6cm。异常闭孔动脉出现率为 14 85 % ,平均直径为 0 2 3± 0 0 8cm。结论腹股沟三角的境界无性别和侧别差异 (p >0 0 5 ) ;通过腹部 3点 1面可确定腹股沟三角的体表投影。腹壁下动脉的外径和长度足以用于冠状动脉旁路移植物。异常壁孔动脉出现率较高 ,其直径与腹壁下动脉相近 ,在股疝手术时容易损伤。     

第1掌背动脉逆行岛状皮瓣的应用解剖学

目的　提供第1掌背动脉逆行岛状皮瓣的应用解剖学依据。 方法　解剖58侧防腐固定的成尸手标本,观测第1掌背动脉的起源、外径、长度及吻合。观察皮瓣感觉神经的来源及分布。1侧新鲜成尸手标本动脉造影。 结果　第1掌背动脉起于桡动脉鼻烟窝段,外径（0.77±0.19）mm,长度（5.21±　0.47）cm。第1掌背动脉分为3型：Ⅰ正常型占60%（35侧）,走行在第2掌骨桡侧,在第2掌骨颈或示指近节桡侧与示指桡掌侧固有动脉吻合。Ⅱ变异型占29.2%（17侧）,Ⅲ缺如型占10.3%（6侧）。第1掌背动脉伴行静脉两支者占29%（17侧）;1支者占19%（11侧）;缺如占52%（30侧）。皮瓣的感觉神经来源于桡神经浅支。 结论　第1掌背动脉作为轴心血管设计为逆行岛状皮瓣修复拇指、示指近节及掌指关节背侧皮肤缺损。     

虎口区背侧逆行岛状皮瓣的应用解剖

目的:研究虎口区背侧逆行岛状皮瓣的血供.方法:解剖30侧成尸手标本,观测拇指尺侧指背动脉的来源、走行、分支及分布范围.结果:拇指尺侧指背动脉起点外径(1.0±0.3)mm,走行于拇长伸肌腱尺侧,其来源有3种类型:①第1掌背动脉型,即拇指尺侧指背动脉来源于第1掌背动脉43.3%;②拇主要动脉型,即拇指尺侧指背动脉来源于拇主要动脉46.7%;③混合型,即第1掌背动脉与拇主要动脉吻合后发出拇指尺侧指背动脉10.0%.结论:虎口区背侧逆行岛状皮瓣操作简便、质地良好、外形美观、血供可靠,是修复拇指及第2掌指关节处皮肤缺损的理想皮瓣.     

(膕)窝中间皮动脉岛状皮瓣的解剖研究

目的:设计以(膕)窝中间皮动脉为蒂的岛状皮瓣.方法:通过对10侧新鲜成人下肢标本的显微解剖研究,系统观测(膕)窝中间皮动脉及其上行支的起始、走行、外径、分支、伴行静脉及供血范围.结果:(膕)窝中间皮动脉均起自朋动脉;起始点位于股骨内外髁连线中点上方(28.50±4.92)mm;起点外径(1.92±0.12)mm;上行支长度(250.03±9.24)mm;末端外径(0.33±0.09)mm;皮支(21±3)条;供血范围在股后区25cm×10cm.有两条伴行静脉,外径(1.41±0.1)mm.结论:(膕)窝中间皮动脉上行支起点、走行恒定,外径较粗,有较多皮支和恒定的供血范围,可设计以股后为供区的逆行岛状皮瓣.     

指背动脉蒂逆行岛状皮瓣的应用解剖

目的：报道指背动脉蒂逆行岛状皮瓣设计的解剖学基础。方法：对12只新鲜尸体手标本分别经动脉灌注红色乳胶及动脉铸型标本对照观察，对掌背动脉及指背动脉进行显微解剖，根据其血管分布设计成指背动脉蒂逆行岛状皮瓣。结果：掌背动脉与指掌侧固有动脉在近节指骨底有交通支相连，掌背动脉的终末支-指背动脉，位于指背腱膜的两侧，一般不超过近节指骨中部，有小分支与指掌侧固有动脉的背侧分支在指背形成丰富的血管吻合网。结论：指背动脉与指掌侧固有动脉的吻合支丰富，可以其为蒂，设计成逆行岛状皮瓣，该皮瓣设计合理、血供可靠、操作简便，是手指末端软组织缺损修复较理想皮瓣。     

第二和第三掌背动脉皮支皮瓣的应用解剖

目的为掌背动脉远段皮支皮瓣的设计提供解剖学依据。方法在10侧成人手标本动脉乳胶灌注后,解剖观测第2、3掌背动脉走行,皮支的起始部位、走行、外径和吻合方式,模拟掌背动脉皮支皮瓣的切取方法。结果第2、3掌背动脉位置恒定,其皮支发出部位主要集中在远1/3段,直径大于0.2mm者占15%,小于0.2mm占85%,可解剖长度大于20mm;在指蹼处指蹼动脉1～3支,大于0.3mm者为1支,可解剖长度超过10mm。结论以掌背动脉远段皮支为蒂可设计顺行或逆行皮支皮瓣,修复近、中手指皮肤缺损。以指蹼动脉为蒂的顺行皮瓣可修复近、中节手指掌侧皮肤缺损。皮瓣面积以不超过20mm×40mm为宜。     

第3掌背动脉逆行岛状皮瓣掌侧移位修复拇指指端缺损

目的：报道应用第3掌背动脉逆行岛状皮瓣掌侧移位修复拇指指端缺损的手术方法。方法：对22例拇指指端缺损病例，采用第3掌背动脉岛状皮瓣，经指蹼皮下隧道逆行移位至手掌侧远端，屈曲拇指贴紧手掌固定，皮瓣带蒂修复创面，2～3周后断蒂。结果：22例皮瓣全部成活，随访3～12个月，感觉恢复S3 15例、S4 7例，外形及功能满意。结论：第3掌背动脉逆行岛状皮瓣掌侧移位是修复拇指指端缺损的良好方法。     

The second dorsal metacarpal artery chain-link flap: an anatomical study and a case report

Purpose

The purpose of this study was to discuss the distribution characteristics and the anatomical angioarchitecture of cutaneous branches arising from the second dorsal metacarpal artery for the repair of small tissue defects in the hand or fingers using the second dorsal metacarpal artery chain-link flap.

Methods

Fifteen fresh human cadaveric hands were studied using three methods: latex perfusion for microanatomical analysis, denaturation of material and vinyl chloride mixed packing for cast specimens, and latex perfusion creating pellucid specimens. Cutaneous perforators with a diameter of 0.2 mm or greater were evaluated using statistical analysis. Cluster analysis was conducted to determine the overall distribution of the perforators.

Results

Two main clusters of perforators distributed at a relative distance of 40.8 and 68.6 % from the second web space edge to the midpoint of the second metacarpal bone as a unit. The Chi-square analysis revealed no significant differences in either the radial or ulnar side distribution of the cutaneous perforators from the second dorsal metacarpal artery (p = 0.779). Chain-links formed among adjacent perforators were parallel to the axis of the second metacarpal bone on the dorsum of the hand. Based on the anatomic characteristic, we designed the second dorsal metacarpal artery chain-link flap to recover the defect in the index finger. As a result, the patient was satisfied with the appearance and function.

Conclusion

This study indicates that there are two main clusters of arterioles in the distal second dorsal metacarpal artery that can be helpful for the second dorsal metacarpal artery pedicle cutaneous chain-link perforator flaps in the repair of defects in the fingers.

     

The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application

It is well known that a cutaneous artery is constantly located near a cutaneous peripheral nerve, forming a vascular plexus around it. This vascular axis can be either a true artery or an interlacing network, ensuring the vascularization of the nerve and giving off several neurocutaneous perforators to the skin. The anatomy of the accompanying arteries of the dorsal branch of the ulnar nerve (DBUN) and their relationships with the dorsal branch of the ulnar artery (DBUA) were investigated in 22 fresh upper limbs injected with colored neoprene latex. A constant perineural vascularization of the terminal branch of the DBUN was observed in the fourth web space, connected distally with the corresponding dorsal metacarpal or palmar digital arteries. Our findings therefore provide anatomical bases for a new neurocutaneous island flap. Moreover, they allow us to describe a precise surgical technique in order to raise this flap over the larger branch of the DBUN, in the fourth intermetacarpal space. The flap is harvested on the medial aspect of the dorsum of the hand, and its point of rotation is located in the fourth web space, 1 cm proximal to the metacarpophalangeal joint. It is supplied by a reversed flow originating from distal anastomoses of the perineural vessel with the dorsal metacarpal and digital palmar arteries in the fourth web space. This flap does not involve in its pedicle the distal course of the DBUA. It represents a pure neurocutaneous flap.     

指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖

目的为指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣提供系统翔实的解剖学依据。方法14只新鲜成人尸体手标本,灌注红色乳胶,手术显微镜下解剖观测手背和2～5指指背血管的走行、分布、吻合情况及外径。结果手指近、中节每侧各有1～7支间接背侧皮支,2～8支背侧皮支。手指近节中段、近节远段、中节近段或中段每侧较为恒定的存在一支较粗大的指固有动脉背侧皮支,皮支平均外径通常≥0.30mm。掌背动脉终末段和远端掌深弓穿支的指背分支在近节指背与指固有动脉背侧皮支交通。不同节段指固有动脉背侧皮支在指背外侧缘交互吻合,在指背外侧缘形成一条营养血管链。结论以指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣解剖简单、快捷,旋转弧长,利于修复手指中远节较大面积的软组织缺损。     

Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers

Several flaps have been described to treat severe soft tissue defects of the finger dorsal side. Many authors studied vascular organization of the hand on its dorsal side; most of them insisted on deep vascularization into the intermetacarpal spaces, which is formed by the dorsal metacarpal arteries. Those dorsal metacarpal arteries are the anatomical support of many flaps, which do not preserve the dorsal interosseous muscles fascias. Only few authors described dorsal vascular organization at the level of the proximal phalanx; however, using a rotation point of a flap distally to the metacarpal head with a donor site on the dorsal aspect of the hand could cover all distal soft tissue defect of long finger. In order to determine the technical limitations of dorsal digito-metacarpal flap procedures, we studied number and location of arterial anastomoses between the reticular subcutaneous dorsal network and the rest of the vascularization at this level, which was formed by the deeper dorsal metacarpal arteries, common palmar digital arteries and proper palmar digital arteries, and between the dorsal digital arteries. Twenty-four long fingers from embalmed cadavers were studied after a reverse flow injection of colored latex and dissected layer-by-layer preserving the digital-metacarpal arterial network. At the level of the hand, the dorsal metacarpal arteries of the third and fourth intermetacarpal spaces were inconstant. When present, two or three arteries anastomosed in star shape with the reticular network. No such arterial anastomosis was observed proximally to the level of the intertendinous connections (junctura tendinorum) that bridge the extensor digitorum communis tendons. When no dorsal metacarpal artery was present, some communicant arteries arose from the common palmar digital arteries. Moreover, all the nutrient branches were more numerous distally to the intertendinous connections (junctura tendinorum). At the level of the metacarpophalangeal joints, the hand cutaneous network was always anastomosed with the dorsal cutaneous network. At the level of fingers, the dorsal cutaneous network was always supplied by four branches arising from the proper digital artery. Our study supported the reliability of dorsal digitometacarpal flaps, supplied by numerous palmodorsal digital anastomoses and by a rich plexiforme network joining the hand skin supply and that of the dorsal finger skin. During the procedure, we recommend limiting the surgical dissection of the flap at the level of the middle phalanx.     

虎口掌侧动脉背侧穿支蒂跨区供血皮瓣的解剖基础

目的　探讨虎口掌侧动脉背侧穿支形态学特征,为虎口掌侧动脉背侧穿支皮瓣设计提供解剖学基础。 方法　用30侧灌注红色乳胶的成尸手标本,通过巨微解剖、血管铸型等方法,重点观测：①虎口背侧营养血管的起源、走行与分布;②虎口掌侧动脉背侧穿支与虎口背侧血管的吻合特点。另1侧灌注红色乳胶的新鲜标本进行摹拟手术设计。 结果　虎口背侧血供属多源性,由虎口掌侧动脉（示指桡掌侧固有动脉、拇指尺掌侧固有动脉）背侧穿支和虎口背侧动脉（第1掌背动脉）分支供养。①第1掌背动脉恒定起自桡动脉,走行于第1掌骨间隙,分出桡侧、尺侧和中间3个终支,有桡神经浅支发出的同名指背皮神经伴行;②虎口掌侧动脉向虎口背侧发出尺侧、中间和桡侧穿支,与第1掌背动脉分支形成恒定的吻合,营养虎口背侧皮肤。 结论　以虎口掌侧动脉背侧穿支为蒂,可形成跨区域供血虎口背侧皮瓣转位修复示指近侧段、鱼际部和拇指软组织缺损。     

前臂骨间背动脉蒂岛状皮瓣创面修复7例报告

目的 探讨前臂背侧骨间背动脉蒂岛状皮瓣行创面修复的手术方法 和效果.方法 2001年3月～2008年2月采用该皮瓣修复创面7例,其中逆行皮瓣修复手部创面6例,顺行皮瓣转移修复肘部创面1例.结果 皮瓣全部成活,无坏死及感染.术后随访3个月至1年,患肢功能恢复满意.结论 前臂骨间背动脉蒂岛状皮瓣修复上肢创面操作简单,疗效可靠.