大鱼际皮瓣的解剖学基础及临床应用  

Anatomical basis of the greater thenar flap and its clinical application

作　　者：李文庆[1] 王钢[1] 徐达传[2] 张鹏[3] 王文胜[3] 王利[3] 宫云霞[3] 

机构地区：[1]南方医科大学附属南方医院创伤骨科中心 [2]南方医科大学临床解剖学研究所,广州510515 [3]深圳市南山区人民医院手外科,深圳518052

出　　处：《中国临床解剖学杂志》2007年第2期217-220,共4页Chinese Journal of Clinical Anatomy

摘　　要：目的:介绍大鱼际皮瓣的血管解剖学基础,以及临床应用经验。方法:解剖20侧经动脉灌注红色乳胶的成人手标本,观察大鱼际皮肤的血供来源、走行、分支及吻合情况。临床切取3种不同设计的大鱼际皮瓣,修复拇指软组织缺损共计14例。结果:大鱼际皮肤的血供来源主要有4个方面:(1)由掌浅支或其发出的拇指桡侧指动脉发出的皮支;(2)来源于拇主要动脉的拇指桡侧指动脉发出的皮穿支;(3)拇指桡侧指背动脉向大鱼际桡背侧发出的皮支;(4)大鱼际深部血管发出的肌皮穿支。上述这些血管在大鱼际交织成网状,营养整个大鱼际皮肤。临床应用以掌浅支(弓)发出的拇指桡侧指动脉为血管蒂的大鱼际皮瓣4例,拇指桡侧指动脉穿支蒂皮瓣7例,大鱼际桡背侧筋膜血管蒂皮瓣4例,皮瓣全部成活,其中1例指动脉穿支皮瓣远端约4mm坏死,结痂后自行脱落。术后随访半年～2年,平均10个月,皮瓣血运、质地、弹性良好,外形美观。结论:三种皮瓣疗效可靠,是修复拇指软组织缺损的理想方法。临床上可依具体情况选择不同的方法来修复。Objective：To introduce anatomic basis of vessels of greater thenar flap and its clinical application. Methods： The origin, courses, branches and anastomosis of the greater thenar vessels were observed on 20 adult cadaveric hand specimens perfused with red gelatin in arteries. According to the anatomic characteristics of blood supply in greater thenar skin, three kinds of flaps with pedicle were designed to repair the thumb soft tissue defect in 14 cases. Results：The origin of the greater thenar vessels was as four aspects： （1） The cutaneous branches came from the superficial palmar branch of radial artery or its thumb radial-palmar digital artery. （2） The cutaneous branches came from the thumb radial-palmar digital artery which was from the thumb principal artery. （3） The cutaneous branches came from the thumb radial-dorsal artery, which distributed on the radial thenar. （4） The musculocutaneous perforators were from the deep vessel in thenar. Vessels mentioned above formed a vessel net to supply thenar skin. In clinic, 4 cases were treated with thenar flaps pedicled with thumb radial-palmar digital artery originated from the superficial palmar branch of radial artery, 7 cases with the thumb radial-palmar digital artery perforator flaps, and 3 cases with the radial-dorsal thenar fasciocutaneous flap. All flaps survived, however 4mm margin skin necrosis happened in 1 case, which healed after decrustation. After 6 to 24 months postoperative follow-up （the average of 10 months）, the blood supply and texture of the flaps were excellent, their appearance and function were satisfactory. Conclusions：Three kinds of thenar flaps are safe and reliable. They are ideal methods for repairing thumb soft tissue defect. Different methods should be chose according to the situation of tissue defect.

关 键 词：大鱼际 血管解剖 外科皮瓣 修复 

分 类 号：R323.71[医药卫生—人体解剖和组织胚胎学] R616.2[医药卫生—基础医学]