论文部分内容阅读
背景:前臂皮神经营养血管皮瓣特别适宜手部远端的组织缺损修复,所以了解贵要静脉远端的营养血管及与邻近骨、皮和前臂内侧皮神经的血供关系对临床上前臂皮神经营养血管远端蒂复合瓣的设计有重要意义。目的:研究前臂尺侧缘远端的动脉穿支,为前臂尺侧缘贵要静脉营养血管远端蒂复合瓣的设计提出解剖学理论。设计:单一样本实验。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30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30侧成人上肢标本,以尺骨茎突为观测标志点进行显微解剖。主要观察指标:重点观察:①前臂尺侧缘远端的动脉穿支来源。②动脉穿支与贵要静脉远端的营养血管。③营养血管与邻近骨、皮和前臂内侧皮神经的血供关系。④贵要静脉的浅深交通支。结果:①前臂尺侧缘远端的动脉穿支来自:尺动脉的皮支5～9支,外径(0.7±0.3)mm,尺动脉腕上皮支1～3支,外径(0.6±0.3)mm。在尺骨茎突上方6.0～16.0cm,骨间前动脉发骨皮穿支二三支,骨间后动脉发骨皮穿支1～3支,二者外径在0.4～1.2mm,分布尺骨中下段骨膜及相应区域的皮肤。②上述动脉穿支均发皮支、筋膜支、骨膜支、贵要静脉和皮神经营养血管支,形成贵要静脉旁血管链和皮神经干血管链以及深、浅筋膜和骨膜血管网。结论:前臂尺侧缘远端的动脉穿支是贵要静脉营养血管的来源,营养血管与邻近的骨、皮和前臂内侧皮神经的营养血管同源,是设计贵要静脉营养血管远端蒂复合瓣的解剖学基础。以尺动脉腕上皮支为蒂的远端蒂复合瓣,旋转轴点可达腕关节平面,用于转位修复手部远处的组织缺损。
BACKGROUND: Forearm cutaneous neurovascular flaps are particularly suitable for the repair of tissue defects in the distal part of the hand. Therefore, it is important to understand the relationship between the nutrient vessels in the distal part of your vein and the blood supply to the medial cutaneous nerve of the adjacent bones, Neurotrophic vascular distal pedicle flap design is of great significance. OBJECTIVE: To study the arterial perforation distal to the ulnar margin of the forearm and to propose an anatomical theory for the design of the distal pedicled composite flap of the nutrient veins of the superior vena cava on the ulnar side of the ulnar forearm. Design: Single sample experiment. Unit: PLA Military Hospital, Fuzhou General Hospital of Military Orthopedic Research Clinical Anatomy Research Center. MATERIALS: The experiment was performed at the Laboratory of Clinical Anatomy Research Center, Military Academy of Orthopedics, Fuzhou General Hospital of PLA, Nanjing Military Region from May 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, Military Academy of Orthopedics, Fuzhou General Hospital of Nanjing Military Region). Methods: Thirty adult adult upper extremity specimens were dissected microscopically with ulna styloid process. MAIN OUTCOME MEASURES: Key observations: ① The origin of the artery perforator distal to the lateral margin of the forearm ulnar. ② arterial perforation and the distal vein nutrition expensive blood vessels. ③ nutrient vessels and adjacent bone, skin and forearm medial cutaneous nerve blood supply relationship. ④ expensive vein deep traffic branch. Results: ① The perforators of the distal side of the forearm ulnar originated from 5 to 9 branches of the ulnar artery with an outer diameter of 0.7 ± 0.3 mm, 1 to 3 branches of the ulnar artery of the ulnar artery and an outer diameter of 0.6 ± 0.3 ) mm. In the superior ulna styloid process 6.0 ~ 16.0cm, anterior interosseous artery perforated bone perforation two or three, interosseous artery disseminated perforator 1 to 3, both outside diameter 0.4 ~ 1.2mm, distribution in the ulna The lower periosteum and the corresponding area of the skin. ② The arterial perforator branch of the skin, fascia, periosteum, your vein and the cutaneous nerve nutrient vessel branch, the formation of expensive to the paraventricular blood vessels and the dermal trunk vascular chain and deep, superficial fascia and periosteal vascular network . CONCLUSIONS: The arterial perforator distal to the lateral ulnar margin of the forearm is the source of nutrient vessels in the parenchyma veins. Nutrient vessels are homologous to the nutrient vessels of the adjacent medial cutaneous nerve of the bones, skins and forearms. Anatomical basis of composite flap. Distal pedicle flap pedicled with the ulnar artery of the ulnar artery, the axis of rotation up to the wrist joint plane for transposition to repair tissue defects at the distal hand.