拇指尺侧指背动脉为蒂的虎口背侧逆行岛状皮瓣的解剖与临床应用  

Anatomy and clinic application of reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle

作　　者：史增元[1] 尹维刚[2] 俞淼[1] 董文伟[1] 毛海蛟[1] 唐旭[1] 

机构地区：[1] 宁波大学医学院附属医院骨科, 浙江省宁波市,315020 [2] 宁波大学

出　　处：《中华显微外科杂志》2014年第1期63-66,共4页Chinese Journal of Microsurgery

摘　　要：目的 探讨拇指尺侧指背动脉为蒂虎口背侧逆行岛状皮瓣修复拇指皮肤缺损的手术方法.方法 用70侧成人尸手标本,经动脉灌注红色乳胶,解剖观测拇指尺侧指背动脉的来源、走行和分布范围.在临床上应用该逆行岛状皮瓣修复8例拇指皮肤缺损,切取面积为4.5 cmx3.0cm～7.5 cmx4.0cm. 结果 拇指尺侧指背动脉分为4种类型：Ⅰ型为肌外型,即该动脉起源于第1掌背动脉,走行在第1骨间背侧肌表面,占42.9％；Ⅱ型为肌内型,即该动脉起源于拇主要动脉或桡动脉深支,走行在第1骨间背侧肌深面,占41.4％；Ⅲ型为混合型,即该动脉起源于拇主要动脉与第1掌背动脉在第1掌指关节水平的吻合处,占11.4％；Ⅳ型为缺如型,占4.3％.临床应用8例皮瓣全部成活.术后平均随访8个月,皮瓣质地良好,外形满意,虎口功能正常. 结论 拇指尺侧指背动脉变异较大,术中要探查该动脉的类型,以决定手术方法.该皮瓣手术操作简便,对供区影响小,是修复拇指皮肤缺损的理想皮瓣.Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cmx 3.0 cm to 7.5 cmx 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle（42.9%）.Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle（41.4%）.Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint（11.4%）.Type Ⅳ was absence type （4.3%）.Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery;s considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.

关 键 词：拇指 拇尺侧指背动脉 岛状皮瓣 虎口区 应用解剖 皮肤缺损 

分 类 号：R658.2[医药卫生—外科学]