前臂背侧远端动脉穿支显微解剖与前臂后皮神经营养血管移植皮瓣的设计_英文__cropped

前臂背侧远端动脉穿支显微解剖与前臂后皮神经营养血管移植皮瓣的设计_英文__cropped 11 卷 第 8 期 2007- 02- 25 出版 第 中国组织工程研究与临床康复 J ourna l of Clinica l Re ha bilita tive Tis s ue Engine e ring Re s e a rch Fe brua ry 2 5 , 2007 Vol.11 , No .8 CRTER Ba s ic Me d ic in e Mic r a d is s e c t io n o f d is t a l a n t e b r a c h ia l a r t e r ia l p e r fo r a t o r s o f d o r s a l fo r e a r m a n d d e s ig n o f fla p p e d ic le d w it h n u t r ie n t v e s s e ls o f n e r v e * p o s t e r io r a n t e b r a c h ia l c u t a n e o u s Z h a n g Fa - h u i, Z h e n g He - p in g , Z h a n g Gu o - d o n g Re s e a rching Ce nte r Ab s t r a c t of Clinica l Ana tomy, BACKGROUND: P os te rior a nte bra chia l s kin is be ne ficia l for re pa iring injury of dors um of ha nd; howe ve r, a ccording to la ck- Ins titute of Or- thopa e dics , Fuzhou ing ope ra tive re s e a rche s on dis ta l pe dice l a rte ria l pe rfora tors of pos te rior a nte bra chia l cuta ne ous ne rve nutrie nt ve s s e l Ge ne ra l Hos pita l of fla p, it is s till a confus ing proble m in clinic. Na njing Milita ry Are a Comma nd of Chine s e P LA, Fuzhou OBJ ECTI VE: To inve s tiga te the fe a ture s of dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm a nd provide a na tom i- 350025, Fujia n ca l the orie s for s uita ble de s igning pe dicle fla p a nd com pound fla p a t dis ta l fla p pe dicle d with nutrie nt ve s s e ls of pos te rior P rovince , China a nte bra chia l cuta ne ous ne rve . Zha ng Fa -hui, Chie f phys icia n, Ma s te r's tu- DESI GN: S ingle s a m ple obs e rva tion. tor, Re s e a rching Ce n- te r of Clinica l Ana to- my, Ins titute of Or- SETTI NG: Re s e a rching Ce nte r of Clinica l Ana tom y, Milita ry Ins titute of Orthopa e dics , Fuzhou Ge ne ra l Hos pita l of Na n- thopa e dics , Fuzhou jing Milita ry Are a Com m a nd of Chine s e P LA. Ge ne ra l Hos pita l of Na njing Milita ry Are a Comma nd of Chine s e MATERI ALS: The e xpe rim e nt wa s ca rrie d out a t the Re s e a rching Ce nte r of Clinica l Ana tom y, Milita ry Ins titute of Or- P LA, Fuzhou thopa e dics , Fuzhou Ge ne ra l Hos pita l of Na njing Milita ry Are a Com m a nd of Chine s e P LA from Ma y to Octobe r, 2004. Thir- 350025, Fujia n P rovince , China ty-thre e uppe r lim bs of a dult ca da ve rs pe rfus e d with re d la te x through a rte rie s we re provide d by Re s e a rching Ce nte r of zfh4865@ 163.com Clinica l Ana tom y, Milita ry Ins titute of Orthopa e dics , Fuzhou Ge ne ra l Hos pita l of Na njing Milita ry Are a Com m a nd of P LA. S upporte d by: the Na tura l S cie nce Foun- METHODS: Thirty-thre e a dults uppe r lim bs we re dis s e cte d a nd obs e rve d with m icros cope with ta king rhe s tyloid proce s s da tion of Fujia n of ulna a nd ra dius a s pivot point. P rovince , No. C0510034* MAI N OUTCOME MEASURES: ? Dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm ; ? nutrie nt ve s s e ls of dis ta l pos - Re ce ive d: 2006-08-26 te rior a nte bra chia l cuta ne ous ne rve ; ? the ir blood s upply re la tions hip with ne a rby m us cle , bone a nd s kin.Acce pte d: 2006-09-08 (06-50-8-6436/N) RESULTS: ? Along e xte ns or digitorum com m unis m us cle , dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm we re Zha ng FH, Zhe ng HP , pe rfora te d a long bila te ra l m us cula r inte rs pa ce a nd te ndon inte rs pa ce to form la te ra l a nd inte rior inos cula te d va s cula r Zha ng GD. ple xus e s of fa s cia . The a xis of la te ra l m us cle inte rs pa ce , dors a l a nte bra chia l la te ra l va s cula r ple xus e s cons is te d of la te ra l Micra dis s e ction of dis ta l a nte bra chia l bra nch of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry, ra dia l inte ros s e ous cuta ne ous pe rfora tors , ra dia l in- a rte ria l pe rfora tors of te ros s e ous cuta ne ous pe rfora tors of pos te rior inte ros s e ous a rte ry, ca rpa l dors a l bra nch of ra dia l a rte ry a nd its pe rfora - dors a l fore a rm a nd tors . The a xis of m e dia l m us cle inte rs pa ce , dors a l a nte bra chia l m e dia l va s cula r ple xus e s wa s cons is te d of m e dia l bra nch de s ign of fla p pe dicle d with nutrie nt of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry, ulna ris inte ros s e ous cuta ne ous pe rfora tors , ulna ris inte ros s e ous ve s s e ls of pos te rior cuta ne ous pe rfora tors of pos te rior inte ros s e ous a rte ry, ca rpa l dors a l bra nch of ulna ris a rte ry a nd its pe rfora tors . ? a nte bra chia l Above m e ntione d a rte ria l pe rfora tors s e nt out cuta ne ous bra nche s , fa s cia bra nche s a nd pos te rior a nte bra chia l cuta ne ous cuta ne ous ne rve . Zhongguo Zuzhi ne rve nutrie nt ve s s e l to form va s cula r cha in of cuta ne ous ne rve s te m a nd va s cula r ne ts of de e p a nd s upe rficia l fa s cia . Gongche ng Ya njiu yu Mus cle -pe rios te um bra nche s of pos te rior inte ros s e ous a rte ry ha d s om e ulna r pe rios te a whos e ra dia l inte ros s e ous cuta - Linchua ng Ka ngfu 2007;11 (8):1559-1562 ne ous pe rfora tors we re a na s toim os e d with pe rios te um ve s s e ls in the m iddle a nd infe rior s e gm e nts of ra dius ; the re fore , (China ) the re wa s a n a na tom ic ba s is for dis ta l pe dice le com pound fla p. [www.zglckf.om/ zglckf/e journa l/ CONCLUSI ON: Blood s upply of dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm is cha ra cte rize d by m ultiple upfile s /07-8/ s ource s , obvious ly longitudina l dis tribution a nd hom ologous nutrie nt ve s s e l; the re fore , the re a re thre e blood-s upplie d dis - 8k-1559(ps ).pdf] ta l pe dicle d fla p or com pound fla p of pos te rior a nte bra chia l cuta ne ous ne rve nutrie nt ve s s e l. Rota tion point of dis ta l pe di- clde fla p ca n re a ch wris t joint, a nd the com pound fla p ca n be a pplie d in re pa iring the injury of dis ta l tis s ue of ha nd. thos e of ha nd . The re fore , it is be ne ficia l for re pa iring dor- [ 1- 8 ] s um a nd a ttra cts s o m uch a tte ntion . Howe ve r, a c cord - IN T R O DU C T IO N ing to la cking ope ra tive re s e a rche s on dis ta l pe dice l a rte - ria l pe rfora tors of pos te rior a nte bra chia l cuta ne ous ne rve [ 1 ] On the ba s is of a na tom y, Be rte lli e t a l re port the clini- nutrie nt ve s s e l fla p , it is s till a confus ing proble m in clinic . ca l a pplica tion of dis ta l fla p pe dicle d with nutrie nt ve s s e ls Re s e a rch on dis ta l fla p pe dicle d with nutrie nt ve s s e ls of of pos te rior a nte bra chia l cuta ne ous ne rve , in which it pro - pos te rior a nte bra chia l cuta ne ous ne rve prove tha t nutrie nt vide s a donor s ite of fla p cha ra cte rize d by conve nie nt op - ve s s e l of cuta ne ous ne rve is hom ologous with blood s up - e ra tion a nd high a chie ve m e nt ra tio for re pa iring injury of ply of ne a rby s tructure , s o it ca n be a pplie d in de s igning dis ta l tis s ue of ha nd . P os te rior a nte bra chia l s kin pos s e s s dis ta l fla p pe dicle d with nutrie nt ve s s e ls of pos te rior a nte - fe a ture of fa voura ble qua lity a nd ra re s ubcuta ne ous a di- bra chia l cuta ne ous ne rve com bine d with pe rios te um fla p , pos e tis s ue ; whos e e la s ticity a nd lus te r a re s im ila r with inte ros s e ous fla p or m us cle gra fts s o a s to re pa ir bone [ 9 ] .ulna r a rte ry a nd te ndon pe rfora tors of dors a l ca rpa l bra nch of ul- of de fe ct a nd wound on ha nd This s tudy wa s de s igne d to inve s tiga te the fe a ture s of dis ta l a nte bra chia l a rte ria l pe rfora tors of na r a rte ry (Figure 1), a nd s e nt out one or two pe rfora tors which dors a l fore a rm a nd provide a na tom ica l the o rie s for s uita ble pie rce d from inte rs pa ce be twe e n e xte ns or ca rpi ulna ris m us cle a nd de s igning pe dicle fla p a nd com pound fla p a t dis ta l fla p pe dicle d e xte ns or m us cle of little finge r to s ubcuta ne ous pa rt. The s ta rting e x- with nutrie nt ve s s e ls of pos te rior a nte bra chia l cuta ne ous ne rve . te rna l dia m e te r wa s (0.7?0.2) m m . Do r s a l c a r p a l b r a n c h a n d p e r fo r a t o r s o f r a d ia l a n d u ln a r MAT E R IALS AN D ME T H O DS a r t e r ie s (1 .3 ?0 .3 ) cm a wa y from s tyloid proce s s , ra dia l a rte ry s e nt out dor- r ia ls Ma t e s a l ca rpa l bra nche s , which we re cons is te d of dors a l wris t a rte ria l The e xpe rim e nt wa s ca rrie d out a t the Re s e a rching Ce nte r of Clini- re te . Dors a l ca rpa l bra nch of ra dia l a nd ulna r a rte rie s s e nt out 1 - 3 ca l Ana tom y, Milita ry Ins titute of Orthopa e dics , Fuzhou Ge ne ra l pe rfora tors which pie rce d inte rs pa ce s of dors a l wris t e xte ns or te n - Hos pita l of Na njing Milita ry Are a Com m a nd of Chine s e P LA from don . The s ta rting e xte rna l dia m e te r wa s (0 .6 ?0 .1 ) m m . Ma y to Octobe r, 2004 . Thirty-thre e uppe r lim bs of a dult ca da ve rs pe rfus e d with re d la te x P o s t e r io r in t e r o s s e o u s a r t e r y a n d p e r fo r a t o r s through a rte rie s we re provide d by Re s e a rching Ce nte r of Clinica l P os te rior inte ros s e ous a rte ry pie rce d inte ros s e ous pe rios te um a nd Ana tom y, Milita ry Ins titute of Orthopa e dics , Fuzhou Ge ne ra l Hos pi- e nte re d dors um of ha nd through infe rior boa rde r of s upina tor m us - ta l of Na njing Milita ry Are a Com m a nd of Chine s e P LA. cle . It wa s bifurca te d into s upe rior inte ros s e ous cre s t of ulna r re cur- re nt inte ros s e ous a rte ry. Ma in trun (de s ce nding bra nch ) wa s bifur- Me t h o d s ca te d into ulna r inte ros s e ous cuta ne ous bra nche s a nd ra dia l in - Thirty-thre e a dults uppe r lim bs we re dis s e cte d a nd obs e rve d with te ros s e ous cuta ne ous bra nche s . Ulna r inte ros s e ous cuta ne ous m icros cope with ta king rhe s tyloid proce s s of ulna a nd ra dius a s bra nche s downwa rdly pa s s e d through the inte rs pa ce be twe e n e x- pivot point: ? Dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore - te ns or ca rpi ulna ris m us cle a nd e xte ns or digitorum m us cle , a nd ra - a rm ; ? nutrie nt ve s s e ls of dis ta l pos te rior a nte bra chia l cuta ne ous dia l inte ros s e ous cuta ne ous bra nche s we nt towa rds ra dius through ne rve ; ? the ir blood s upply re la tions hip with ne a rby m us cle , bone the s urfa ce of a bductor pollicis longus . Ne a rby wris t, both of the m a nd s kin . we re a na s toim os e d with ulna r a nd ra dia l inte ros s e ous cuta ne ous bra nche s of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry, re - R E S U LT S s pe ctive ly. Cuta ne ous bra nche s s e nt out from ulna r (1 - 3 bra nche s ) a nd ra dia l inte ros s e ous cuta ne ous bra nche s (1 - 2 bra nche s ) we re Dis t a l a n t e b r a c h ia l a r t e r ia l p e r fo r a t o r s o f d o r s a l fo r e a r m dis tribute d a t dis ta l a nte bra chia l dors um of ha nd , a nd the e xte rna l Do r s a l c a r p a l b r a n c h a n d p e r fo r a t o r s o f a n t e r io r in - dia m e te r wa s (0 .6?0 .5 ) m m (Figure 1 ). t e r o s s e o u s a r t e r y Ante rior inte ros s e ous a rte ry wa s loca te d a t (6.0 ?1.0) cm s upe rior to r ie n t v e s s e ls o f p o s t e r io r Dis t a l fla p p e d ic le d w it h n u t s tyloid proce s s of ra dius which wa s bifurca te d from inte ros s e ous pe - a n t e b r a c h ia l c u t a n e o u s n e r v e rios te um to dors um , in which wa s re ga rde d a s dors a l ca rpa l bra nch, P os te rior a nte bra chia l cuta ne ous ne rve wa s de rive d from ra dia l its e xte rna l dia m e te r wa s (1.3 ?0.2) m m . Ma in trunk of dors a l ca rpa l ne rve . De s ce nt fa s cia wa s s upe rficia lly e m e rge d a t inte rs pa ce be - bra nch clos e ly de s ce nde d a long inte ros s e ous pe rios te um a nd bifur- twe e n la te ra l he a d of trice ps bra chii m us cle a nd bra chiora dia lis ca te d into m e dia l e nding bra nch a nd la te ra l e nding bra nch a t (2.6 ?m us cle a bove e lbow a nd downwa rdly we nt a long la te ra l a rm a nd 0.8) cm s upe rior to s tyloid proce s s of ra dius . The s ta rting e xte rna l pos te rior pa rt of la te ra l e picondyle , the n it wa s bifurca te d into two dia m e te r wa s (0.7 ?0.1) m m a nd (0.9 ?0.1) m m , re s pe ctive ly. Me dia l bra nche s . La te ra l bra nch we nt a long la te ra l borde r of fore a rm the n bra nch a nd la te ra l bra nch we re a na s toim os e d with dors a l ca rpa l re a ching to 1/3 of ra dia l pos te rior fore a rm a nd de cre a s e d a long in - bra nch of ulna r a rte ry a nd ca rpa l dors a l bra nch of ra dia l a rte ry, re - te rs pa ce be twe e n e xte ns or digitorum m us cle a nd e xte ns or ca rpi ul- s pe ctive ly. Ulna r a nd ra dia l inte ros s e ous cuta ne ous bra nche s s e nt na ris m us cle towa rds dors a l wris t. Me dia l bra nch downwa rdly we nt out a t both s ide s of proxim a l dors a l ca rpa l bra nch of a nte rior in- a long infe rior pa rt a nd loca te d a t 1/3 of pos te rior a nd m iddle re - te ros s e ous a rte ry. Initia l point of ra dia l cuta ne ous bra nche s wa s gions of fore a rm . P roxim a l a nd m iddle nutrie nt ve s s e ls of pos te rior (4.5?0.7) cm a wa y from ra dia l s tyloid proce s s a nd the s ta rting e xte r- a nte bra chia l cuta ne ous ne rve we re de rive d from ra dia l a cce s s ory na l dia m e te r wa s (1.0 ?0.2) m m . Am ong the m , ulna r inte ros s e ous a rte ry, m us cula r inte rs pa ce of ra dia l a rte ry a nd pe rfora tors of pos te - cuta ne ous bra nche s pie rce d inte rs pa ce be twe e n e xte ns or digitorum rior inte ros s e ous a rte ry. Dis ta l nutrie nt ve s s e ls we re m a inly de rive d m us cle a nd e xte ns or ha llucis bre vis . The a s ce nding bra nch a na s - from pe rfora tors of dors a l ca rpa l bra nch of a nte rior inte ros s e ous toim os e d with ra dia l inte ros s e ous cuta ne ous bra nche s of pos te rior a rte ry a nd pos te rior inte ros s e ous a rte ry. Whe n pe rfora ting de e p inte ros s e ous a rte ry; the de s ce nding bra nch we nt a long e xte ns or ha l- fa s cia , the a rte ria l pe rfora tors m e ntione d a bove s e nt out cuta ne ous lucis bre vis of ulna r la te ra l m a rgin a nd s e nt out two or thre e cuta - bra nche s , fa s cia bra nche s a nd nutrie nt ve s s e ls of cuta ne ous ne rve . ne ous bra nche s which pie rce d from inte rs pa ce be twe e n e xte ns or P a re nte ra l nutrie nt ve s s e ls of cuta ne ous ne rve s e nt out s upe rior digitorum m us cle a nd e xte ns or ha llucis bre vis to s kin (Figure 1). The a nd infe rior bra nche s , e nte re d ne ura l trunk, inos cula te d with ne igh - s ta rting e xte rna l dia m e te r wa s (0.8?0.1) m m . Bra nche s we re loca te d boring nutrie nt ve s s e ls , a nd form e d a n obvious cha in of nutrie nt a t dis ta l ra dia l dors a l pe rios te um a nd a na s toim os e d with uppe r ve s s e ls of cuta ne ous ne rve . ca rpa l cuta ne ous bra nch of ra dia l a rte ry, re curre nt bra nch of ra dia l s tyloid proce s s a nd te ndon pe rfora tors of dors a l ca rpa l bra nch of ra - T h e ir b lo o d s u p p ly r e la t io n s h ip w it h n e a r b y m u s c le , dia l a rte ry (Figure 1). S ta rting point of ulna r inte ros s e ous cuta ne ous b o n e a n d s k in bra nche s wa s (2.4 ?0.5) cm a wa y from ulna r s tyloid proce s s a nd its In this s tudy, pos te rior inte ros s e ous a rte ry s e nt out 6 - 8 bra nche s s ta rting e xte rna l dia m e te r wa s (0.9 ?0.2) cm . It pie rce d inte rs pa ce of m us cula r pe rios te um with the e xte rna l dia m e te r of 0 .3 - 1 .0 m m . be twe e n e xte ns or ca rpi ulna ris m us cle a nd e xte ns or m us cle of little The y we re dis tribute d a t m iddle a nd s upe rior pa rts of ulna r pe rios - finge r. The a s ce nding bra nch upwa rdly pa s s e d through e xte ns or te um . Whe n it wa s (11 .4?1 .1 ) m m s upe rior to s tyloid proce s s of ca rpi ulna ris m us cle a nd inos cula te d with ulna r inte ros s e ous cuta - ra dius , cuta ne ous pe rfora tors of pos te rior inte ros s e ous a rte ry wa s ne ous bra nche s of pos te rior inte ros s e ous a rte ry; the de s ce nding bra nch we nt a long he a d of ulna a nd loca te d a t dis ta l ulna r pe rios - pe rfora te d through the inte rs pa ce be twe e n e xte ns or digitorum m us - te um a nd s kin, a na s toim os e d with uppe r ca rpa l cuta ne ous bra nche s cle a n d fle xor ca rpi ra dia lis ; a dditiona lly, te rm ina te d bra nche s we re IS S N 1673822 - 5 CN21 -1539/R www.zglckf.com kf23385083 s ina@ .com 张发惠, 等.前臂背侧远端动脉穿支显微解剖与前臂后皮神经营养血管移植皮瓣的设计 CRTER s or ca rpi ulna ris m us cle a nd e xte ns or digitorum com m unis m us cle . a na s toim os e d with m us cula r inte rs pa ce of ra dia l a rte ry a nd dis - Ta king the ce ntra l a xis a s e xte ns or digitorum com m unis m us cle , tribute d in pe rios te um of m iddle ba re a re a of ra dius . The cuta - ne ous bra nche s loca te d a t la te ra l borde r of s kin of m iddle fore a rm , dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm a re pe rfora t- whos e e xte rna l dia m e te r wa s (0 .8 ?0 .2 ) m m . Re curre nt bra nche s of e d a long bila te ra l m us cula r inte rs pa ce a nd te ndon inte rs pa ce to ra dia l s tyloid proce s s re turn bra nche s we re bifurca te d into s ty- form la te ra l a nd m e dia l inos cula te d va s cula r ple xus e s of fa s cia : ? loid-proce s s pe rios te um bra nche s , cuta ne ous bra nche s a nd nutrie nt La te ra l va s cula r ple xus e s of dors a l fore a rm : Ta king the a xis a s la t- ve s s e ls of he a d ve in . Cuta ne ous bra nche s of s nuff toba cco we re e ra lly m us cula r inte rs pa ce , it is cons is te d of la te ra lly e nding bra nch bifurca te d into s upe rior a nd infe rior bra nche s . S upe rior bra nche s of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry, ra dia l in - we re a na s toim os e d with cuta ne ous bra nche s of re curre nt bra nche s te ros s e ous cuta ne ous pe rfora tors , ra dia l inte ros s e ous cuta ne ous of ra dia l s tyloid proce s s re curre nt bra nche s a nd s e nt out ce pha lic pe rfora tors of pos te rior inte ros s e ous a rte ry, ca rpa l dors a l bra nch of ve in a nd nutrie nt ve s s e ls of ra dia l ne rve s upe rficia l bra nch . ra dia l a rte ry a nd its pe rfora tors ; ? m e dia l va s cula r ple xus e s of dor- More- s a l fore a rm : Ta king the a xis a s m e dia lly m us cula r inte rs pa ce , it is ove r, infe rior bra nche s we re loca te d in s kin of s nuff toba cco . cons is te d of m e dia l e nding bra nch of dors a l ca rpa l bra nch of a nte ri- or inte ros s e ous a rte ry, ulna r inte ros s e ous cuta ne ous pe rfora tors , ul- na r inte ros s e ous cuta ne ous pe rfora tors of pos te rior inte ros s e ous a rte ry, ca rpa l dors a l bra nch of ulna r a rte ry a nd its pe rfora tors . Al- though va s cula r ple xus e s of dors a l fore a rm doe s not a ccom pa ny 111 5 with s upe rficia l ve in , ce pha lic ve in upwa rdly pa s s e d a long dis ta l ra - 9 10dius of fore a rm ; a dditiona lly, ba s ilic ve in a ls o upwa rdly pa s s e s a - 7 7 65 long ulna r of fore a rm . S ub-bra nche s of the m a re dis tribute d like ne t 6 8but do not a ccom pa ny with cuta ne ous ne rve . P os te rior bra nche s of 4 34 m e dia l a nd la te ra l a nte bra chia l cuta ne ous ne rve re a ch a nte rior m a r- 3 gin of dors a l fore a rm . The re fore , de e p bra nche s of s upe rficia l ve in be long to cuta ne ous ne rve . Te ndon pe rfora tors s e nt by nutrie nt ve s s e ls , dors a l ca rpa l bra nch of ra dia l a nd ulna r a rte rie s involve in form a tion of nutrie nt ve s s e ls of s upe rficia l ve in . It is thus cle a r tha t dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm a re a n 7 15 15 a na s tom os ing blood s upply s ys te m . In a ddition , m us cle a nd pe - 5 10 rios te a l bra nche s of pos te rior inte ros s e ous a rte ry s upply a ce rta in qua ntity of ulna r pe rios te um a nd ra dia l inte ros s e ous cuta ne ous 417 bra nche s a re a na s toim os e d with pe rios te um ve s s e ls in m iddle a nd 13 12 6infe rior s e gm e nts of ra dius . The re fore , it is prove d tha t nutrie nt 14 47 3ve s s e l of pos te rior a nte bra chia l cuta ne ous ne rve is hom ologous 12 with blood s upply of clos e d s tructure a nd is a s a n a na tom ic ba s is for dis ta l pe dicle com pound fla p . S o , va s cula r cours e of long a xis s hould be a na s toim os e d with tha t of lim bs a nd dis ta l pe dicle d fla p s hould be de s igne d a t the s urfa ce of wris t joint. 3 cm s ubcuta- ne ous fa s cia is ta ke n out, a nd blood s upply of com pound fla p is 1:La te ra l e nding bra nch of dors a l ca rpa l bra nch of a nte rior inte ros s e ous re lia ble . a rte ry; 2:De s ce nding bra nch of ra dia l inte ros s e ous cuta ne ous bra nche s in dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry; 3:Cuta ne ous bra nche s of ca rpa l dors a l bra nch of ra dia l a rte ry; 4:La te ra l e nding cuta ne ous bra nch- De s ig n a n d c o lle c t io n o f d is t a l c o m p o u n d p e d ic le d fla p o f e s of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry; 5:Cuta ne ous bra nche s ; 6:P e rios te um bra nche s ; 7:Exte ns or digitorum m us cle ; 8:Cuta - p o s t e r io r a n t e b r a c h ia l c u t a n e o u s n e r v e n u t r ie n t v e s s e l ne ous bra nche s of re curre nt bra nch of ra dius s tyloid proce s s re turn bra nche s ; 9:Uppe r ca rpa l cuta ne ous bra nche s of ra dia l a rte ry; 10:Exte ns or According to a na tom y of dis ta l blood s upply of dors a l fore a rm , ha llucis bre vis ; 11:S upe rficia l bra nch of ra dia l ne rve ; 12 :Me dia l e nding cu- the re a re thre e blood-s upplie d dis ta l pe dicle d fla p or com pound fla p ta ne ous bra nche s of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry; 13:Uppe r ca rpa l cuta ne ous bra nche s of ulna r a rte ry; 14:Dors a l ca rpa l of pos te rior a nte bra chia l cuta ne ous ne rve nutrie nt ve s s e l. Rota tion bra nch of ulna r ne rve ; 15:Exte ns or ca rpi ulna ris m us cle ; 16:Ulna r in- point of dis ta l pe dicle d fla p ca n re a ch wris t joint a nd be a pplie d to te ros s e ous cuta ne ous bra nche s of pos te rior inte ros s e ous a rte ry; 17:Cuta - ne ous bra nche s of ulna r inte ros s e ous cuta ne ous bra nche s of pos te rior in- re pa ir injury of dis ta l tis s ue of ha nd : ? Ta king a xis a s dors a l a nte - te ros s e ous a rte ry bra chia l m idline, fla p is loca te d a t dors a l fore a rm ; ? Ta king a xis a s Figure 1 Dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm inte rs pa ce of m e dia l m us cle , fla p is loca te d a t ulna r dors a l fore a rm ; ? Ta king a xis a s inte rs pa ce of la te ra l m us cle , fla p is loca te d a t ra - dia l dors a l fore a rm . S kin is cutting a t proxim a l fla p to e xpos ure pos te rior a nte bra chia l DIS C U S S IO N cuta ne ous ne rve a nd liga te d . Borde r of fla p is cut out a nd fla p is lifte d in de e p fa s cia . If ulna r inte ros s e ous fla p is cut, the two m us - R e c o g n it io n o f c o r r e la t io n b e t w e e n d is t a l a n t e b r a c h ia l cle s a re pulle d towa rds both s ide s a long cuta ne ous bra nche s a nd a r t e r ia l p e r fo r a t o r s o f d o r s a l fo r e a r m a n d d is t a l fla p inte rs pa ce be twe e n e xte ns or digitorum m us cle a nd e xte ns or ca rpi p e d ic le d w it h n u t r ie n t v e s s e ls o f p o s t e r io r a n t e b r a c h ia l ulna ris m us cle a t m iddle -s upe rior s e gm e nts of fore a rm to e xpos ure c u t a n e o u s n e r v e s upina tor a nd a bductor pollicis longus . S upina tor is cut e xce pt a Dis ta l a nte bra chia l a rte ria l pe rfora tors of dors a l fore a rm is cha ra c - thin la ye r of m us cula r s le e ve s ; the n , s upina tor is pulle d towa rds ra - te rize d by m ultiple s ource s , obvious ly longitudina l dis tribution a nd dius to e xpos ure a s ce nding a nd de s ce nding bra nche s of pos te rior hom ologous nutrie nt ve s s e l. Arte ria l pe rfora tors be long to dire ctly inte ros s e ous a rte ry a nd pe rios te um bra nche s . Es pe cia lly, pe rios - cuta ne ous pe rfora tors , m us culocuta ne ous pe rfora tors or in - te um bra nche s s hould be prote cte d ca re fully. In a ddition , ulna r fla p te ros s e ous cuta ne ous pe rfora tors with ple ntiful qua ntitie s . The e x- is cut into pie ce s . If ra dia l inte ros s e ous fla p is cut, the two m us cle s te rna l dia m e te r ra nge s from 0 .3 m m to 1 .2 m m a nd the a na s tom o - a re pulle d towa rds both s ide s a long cuta ne ous bra nche s a nd inte r- s ions a re a bunda nt. La te ra l a re a is the inte rs pa ce be twe e n s pa ce be twe e n e xte ns or ca rpi ra dia l m us cle a nd fle xor ca rpi ra dia lis s hort-e xte ns or m us cle s of ra dia l wris t a nd e xte ns or digitorum com - (e xte ns or digitoru m m us cle , a bductor pollicis longus a nd e xte ns or m unis m us cle ; while, m e dia l a re a is the inte rs pa ce be twe e n e xte n - Za zhi 2002;25(4):247-248 ha llucis bre vis ) a t s upe rior s e gm e nts of a bductor pollicis longus to XK Fu, Y Wa ng, YQ Zha ng, e t a l.The clinica l a pplica tion of the 8 e xpos ure ra dia l ba re re gion . More ove r, a ccording to cours e of in - re trogra de -flow is la ndfla ps pe dicle d with the ne urocuta ne ous colla te ra l te ros s e ous s urfa ce of ve s s e l of m us cula r inte rs pa ce , pe rios te um ve s s e ls in the ha nd a nd fore a rm . Zhonghua Xia nwe iwa ike Za zhi 1997;20 fla p is cut with the s ize of 6 .0 cm ×2 .0 cm . Afte r s ucce s s ful e s ta b - (3):192-194 lis hm e nt of pe rios te um fla p , s kin of pe dice l is cut ope n a nd fre e Zha ng FH, Zhe ng HP , Tia n WC,e t a l.Applie d a na tom y of the com pound 9 fla p of dis ta lly ba s e d pe dicle d with nutritiona l ve s s e ls of the la te ra l pe dice l a t s ubcuta ne ous pa rt re a ch rota tion point. While, va s cula r cuta ne ous ne rve of fore a rm a nd ce pha lic ve in. Zhongguo Linchua ng pe rfora tors ca n be found a t ba s ila r pa rt of dis ta l pe dice l. Fla p in J ie pouxue Za zhi 2005;23(2):118-121 s ubcuta ne ous tunne l or incis ion a re a a nd s kin a t rota tion point ca n re a ch dis ta l dors um of ha nd . At this tim e , cuta ne ous pe rfora tors of dors a l ca rpa l bra nch of pos te rior inte ros s e ous a rte ry a re obs e rve d 前臂背侧远端动脉穿支显微解剖与前臂后a t both s ide s of ba s ila r pa rt of dis ta l pe dice l. 皮神经营养血管移植皮瓣的设计 * Ma in a n a t o m ic p o in t s in c lin ic a l a p p lic a t io n 张发惠, 郑和平, 张国栋The clinica lly m a in points a re s hown a s follows: ? Mus cula r inte r- 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, 福建 s pa ce ca n be re ga rde d a s a na tom ic la ndm a rk to find out puncture d 省福州市350025 point of a rte ria l pe rfora tors during ope ra tion . The re fore , Dopple r 张发惠, 男, 1948 年生, 福建省闽侯县人, 汉族, 1985 年解放军福州军区 va s cula r de te ctor is us e d to de te rm ine a rte ria l pe rfora tors be fore 军医学校毕业, 主任医师, 硕士生导师, 主要从事临床应用解剖学方面的 ope ra tion . ? In orde r to re pa ir ulna r wounds of dors um , dis ta l pe di- 研究。ce l s hould s e t a t the s a m e s ide of it a nd m e dia l e nding bra nch of 福建省自然科学基金资助项目( ) C0510034 *dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry is re ga rde d a s the s upplying ve s s e l. In orde r to re pa ir ra dia l wounds of dors um , 摘要背景: 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 dis ta l pe dice l s hould s e t a t the s a m e s ide of it a nd la te ra l e nding , 临床实际应用起来还较为 的远端蒂动脉穿支缺少具体可操作性的研究bra nch of dors a l ca rpa l bra nch of a nte rior inte ros s e ous a rte ry a nd 困难。pe rfora tors a re re ga rde d a s the s upplying ve s s e l. ? During de s igns 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 of pe rios te um fla p a t m iddle -infe rior s e gm e nts of ulna , fla p s hould 皮瓣、复合瓣的合理设计提出解剖学理论。be clos e d to ulna r borde r. ? During de s igns of pe rios te um fla p a t 设计: 单一样本观察。 m iddle -infe rior s e gm e nts of ra dius , ordina te of fla p s hould be a wa y 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 from ra dia l borde r. ? Fla p is cut unde r de e p fa s cia , a nd pe rios - 33 侧动脉灌注红色乳 所临床解剖学研究中心实验室完成。研究材料为 te um fla p or inte ros s e ous fla p s hould be s uture d a nd fixe d s o a s to ( 由南京军区福州总医院军区骨科研究所临床解剖学研 胶成人上肢标本pre ve nt s e pa ra tion be twe e n s kin a nd de e p fa s cia . ? Width of pe di- 究中心提供) 。 ce l is a bout 3 - 4 cm s o a s to include cha ine d va s cula r ple xus s uffi- 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 cie ntly. ? Rota tion point of dis ta l pe dice l s hould not be bifurca te d 解剖。s o a s to pre ve nt dis turba nce of pe riphe ra l va s cula r ne t. ? Rota tion 主要观察指标: ?前臂背侧远端的动脉穿支。?前臂后皮神经远端的营 point is liga te d with s upe rficia l ve in trunk in orde r to pre ve nt re flux- ?营养血管与邻近肌、骨、皮的血供关系。 养血管。ing of dis ta l ve nous blood into fla p . ? S upe rficia l bra nch of ra dius 结果: ?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 ne rve a nd dors a l ca rpa l bra nch of ulna r ne rve a re pa id m uch a tte n - , 构成远端外侧与内侧 2 条纵向的吻合筋膜血管 肌间隙和腱间隙穿出tion in dis ta lly s e pa ra te d a re a . ? Try to find out a ce ntripe ta l dra in - 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 ing ve in in donor a re a , m a ke the m coincide , a nd e s ta blis h a re flux 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 外侧终支、pa s s a ge of s upe rficia l ve in trunk. 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 ?上述动脉穿支发皮支、筋膜支和前臂后皮神 脉腕背支及其穿支组成。R E F E R E N C E S 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 , 其桡侧骨穿皮支与桡骨中下段裸区的骨膜血管 肌骨膜支分布尺骨骨膜吻合, 是构成远端蒂复合瓣的解剖学基础。 Be rte lli J A, Ca ta rina S . Ne urocuta ne ous is la nd fla ps in uppe r lim b cove r- 1 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 a ge : e xpe rie nce with 44 clinica l ca s e s .J Ha nd S urg [Am ]. 1997;22(3): , 可以设计 3 种不同供血的前臂后皮神经营养血管远端蒂 的解剖学特点515-526 , 旋转轴点可达腕关节平面, 适宜手背远侧的组织缺损修 皮瓣或复合瓣Ayya ppa n T, Cha dha A. S upe r s ura l ne urofa s ciocus fla ps in a cute tra u- 2 复。m a tic he e l re cons tructions . P la s t Re cons tr S ury 2002;109(7):2307-2313 关键词: 外科皮瓣; 前臂 / 解剖学和组织学; 前臂 / 血液供给; 前臂 / 神经 3 Ca va da s P C. Re ve rs e d s a phe nous ne urocuta ne ous is la nd fla p: clinica l e xpe rie nce a nd e volution to the pos te rior tibia l pe rfora tor-s a phe nous 支配s ubcuta ne ous fla p. P la s t Re cons tr S urg 2003;111(2):837-839 中图分类号: 文献标识码: 文章编号: R329.4 A 1673-8225(2007)08-01559-04Ca va da s P C. Re ve rs e d s a phe nous ne urocuta ne ous is la nd fla p: 4 clinica l 张发惠, 郑和平, 张国栋前臂背侧远端动脉穿支显微解剖与前臂后皮神经的营养 . e xpe rie nce . P la s t Re cons tr S urg 1997;99(7):1940-1946 血管移植皮瓣的设计 中国组织工程研究与临床康复, , [J ]. 200711(8):1559-1562 5 Be rte lli J A,Khoury Z. Ne urocuta ne ous is la nd fla ps in the ha nd: a na tom i- [www.zglckf.com /zglckf/e journa l/upfile s /07-8/8k-1559(p )s.pdf] ca l ba s is a nd pre lim ina ry re s ults .Br J P la s t S urg 1992;45(8):586-590 (Edite d by Ze ng XL/J i H/Wa ng L) 6 Be rte lli J A,Ka le li T. Re trogra de -flow ne urocuta ne ous is la nd fla ps in the fore a rm : a na tom ic ba s is a nd clinica l re s ults .P la s t Re cons tr S urg 1995;95 (5):851-859 Cha i YM, Lu GK, Che n YG, e t a l.The clinica l a pplica tion of 7 ne urocuta ne ous a xia l is la ndfla ps in the fore a rm . Zhonghua Xia nwe iwa ike