指掌侧固有动脉背侧支皮瓣的显微解剖与临床应用  

Anatomy study and clinical application of island flap based on dorsal cutaneous branches of digital inherent artery

作　　者：张文龙[1] 赵刚[1] 马爱国[1] 侍朋举[1] 张铁山[1] 徐华[1] 李亮[1] 朱鹏飞[1] 

机构地区：[1]河北省唐山市第二医院手二科,唐山063000

出　　处：《中华显微外科杂志》2015年第2期107-110,共4页Chinese Journal of Microsurgery

基　　金：河北省医学科学研究重点课题计划项目（ZD20140403）

摘　　要：目的 对指掌侧固有动脉背侧支显微解剖学观察,总结背侧支分布规律,探讨该背侧支皮瓣修复手指皮肤缺损的手术方法和临床疗效. 方法 2010年1月-2014年3月,用12只新鲜手标本进行红色乳胶灌注,显微解剖观察指掌侧固有动脉背侧支血管的分布规律和特点;以近、中节指掌侧固有动脉背侧支供血的指背皮瓣修复第2～5指皮肤缺损79例98指,同指修复51例60指;邻指修复28例38指.其中示指皮肤缺损39指,中指皮肤缺损22指,环指皮肤缺损29指,小指皮肤缺损8指.合并骨折11例13指;合并肌腱断裂或缺损15例18指;合并血管、神经损伤6例7指.皮瓣切取面积最大为28 mm×20 mm,最小为10 mm×8 mm.结果 解剖发现第2～5指指掌侧固有动脉近节背侧支2～3条,近端背侧支发出点位于近节指骨基底移行部,远端背侧支位于近节指骨颈部.中节背侧支2条,近端背侧支发出点位于中节指骨基底移行部,远端背侧支位于中节指骨颈部,即终末背侧支.临床应用79例98指皮瓣全部成活,其中90指获6～ 27个月随访,平均15.6个月,皮瓣外观及手指功能恢复满意.皮瓣感觉恢复达S3＋,两点辨别觉6～9 mm,平均7.6 mm.供区无并发症. 结论 指掌侧固有动脉背侧支血管发出位置恒定,背侧支间相互吻合呈链网结构,以不同阶段背侧支供血切取皮瓣具有血供可靠、不牺牲主要血管,操作简便、安全,术后效果满意,是修复手指皮肤缺损较为理想的方法。Objective To dissect and measure the dorsal cutaneous branches of digital inherent artery in fresh hand specimens.And explore the therapeutic effect of island flap based on dorsal cutaneous branches of digital inherent artery to repair defect at the same or adjacent finger.Methods From January,2010 to March,2014,the origin,courses and distribution of dorsal cutaneous branches of digital inherent artery from 12 fresh hand specimens perfused by red latex were explored.Ninety-eight fingers in 79 cases with skin defects were treated with island flap based on dorsal cutaneous branches of digital inherent artery for skin defect at the same or adjacent finger.There were 39 index fingers,22 middle fingers,29 ring fingers and 8 little fingers.The size of the flaps ranged from28 mm × 20 mm to 10 mm × 8 mm.Results The proper artery of 2nd-5th fingers proximal segment sent out 2-3 dorsal branches.The proximal dorsal branch lay at the base of the proximal phalanx.The distal dorsal branch lay at the neck of the proximal phalanx.The proper artery of the middle segment sent out 2 dorsal branches.The proximal dorsal branch lay at the base of the proximal phalanx.The distal dorsal branch lay at the neck of the proximal phalanx.,namely the terminal dorsal branch.All flaps survived successfully.The 6-27 months＆#39; followed-up showed that all these flaps recovered with satisfying texture,graded S3＋ sensation,and 6-9 mm two point discrimination.There were no obvious complications of the donor site.Conclusion The flap based on dorsal cutaneous branches of digital inherent artery to repair defect at finger does not sacrifice a major artery and can restore good flap contour.The treatment of finger cutaneous defect with the flap is recommendable.It can be easily and conveniently performed.

关 键 词：指掌侧固有动脉 背侧支 外科皮瓣 显微解剖 指损伤 修复 

分 类 号：R658.2[医药卫生—外科学]