正中神经掌皮支营养血管远端蒂肌皮复合瓣解剖学研究及临床应用  

Anatomic study and clinical application of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch

作　　者：陶圣祥[1] 喻爱喜[1] 郑晓晖[1] 余国荣[1] 

机构地区：[1]武汉大学中南医院骨科,武汉大学医学院显微外科研究所,430071

出　　处：《中华手外科杂志》2008年第5期273-276,共4页Chinese Journal of Hand Surgery

基　　金：湖北省科技攻关基金资助项目（2007AA301B37-1）

摘　　要：目的探讨正中神经掌皮支营养血管肌皮瓣转移术修复拇指组织缺损的解剖学依据及临床效果。方法对30侧成人尸体手标本进行解剖，系统观测正中神经掌皮支营养血管链的组成、分支、分布及其同大鱼际肌相互交通吻合的情况。2007年2月以来，临床应用正中神经掌皮支营养血管远端蒂肌皮瓣转移术修复拇指组织缺损17例。结果桡动脉掌浅支恒定地向拇短展肌和拇短屈肌发出3～5支肌皮穿支，节段性参与正中神经掌皮支营养血管链，肌皮穿支平均外径为[（0．3±0．1）mm，x±s，下同]，均有1条静脉伴行。17例术后肌皮瓣全部存活，拇指外观及功能满意，11例患者在术后1周皮瓣两点分辨觉为（6．1～8．2）mm。结论正中神经掌皮支营养血管链同拇短展肌和拇短屈肌肌皮穿支恒定吻合，该肌皮瓣是修复拇指组织缺损的良好供区。Objective To investigate the anatomical features of neuromyocutaneous flap based on nutritional vessel of median nerve palmar cutaneous branch and evaluate the clinical application of this flap for repairing soft tissue defect of the thumb. Methods Thirty adult cadaver hand specimens wen dissected after red latex perfusion. The configuration, branches, and distributions of the nutritional vessel of median nerve palmar cutaneous branch and its anastomoses with thenar muscle vessels were, observed. Since February 2007, neuromyocutaneous flap distally based on the nutritional vessel of median nerve palmar cutaneous branch was transferred to repair soft tissue defect of 17 thumbs. Results Superficial palmar branch of the radial artery gives out 3-5 myocutaneous perforators to abductor pollicis brevis and flexor pollicis hrevis. Those perforators form the nutrient vessel chain of palmar cutaneous branch of the median nerve. The external diameter of the perforators was （0.3-0.1） mm on average. It is accompanied by one vein. All of the 17 cases of neuromyocutaneous flap survived. The function and appearance of the thumbs were good. One week after the surgery, the average two-point discrimination at thumb pulp resurfaced by the flaps was （6.1-8.2） nml in 11 cases. Conclusion There exists anastomosis between the nutritional vessel chain of median nerve palmar cutaneous branch and the perforators of abductor pollicis brevis and flexor pollicis brevis. The neuromvocutaneous flap is a good option to repair soft tissue defect of the thumb.

关 键 词：外科皮瓣 正中神经 拇指 解剖学 局部 

分 类 号：R686[医药卫生—骨科学]