带尺动脉腕上皮支降支筋膜皮瓣的解剖与临床研究  

Anatomical basis and clinical applications of the distally pedicled dorsoulnar fascial flap based on the dorsal descending branch of the ulnar artery

作　　者：王和驹[1] 陈彦堃[1] 王书成[1] 张燕翔[1] 王快胜[1] 邱勋永[1] 许世忠[1] 

机构地区：[1]海南省人民医院手外科,海口市570311

出　　处：《中华显微外科杂志》2004年第1期13-15,F002,共4页Chinese Journal of Microsurgery

基　　金：海南省卫生厅科研资助项目 (琼卫 2 0 0 0 1 0 )

摘　　要：目的　研究以尺动脉腕上皮支降支为蒂前臂尺侧逆行岛状皮瓣的解剖学基础及临床应用可靠性。　方法　选用红色乳胶及中国墨汁动脉灌注上肢标本共 2 0例 ,上肢动脉铸型标本 5例 ,解剖观察尺动脉腕上皮支降支来源、走行、分布及与腕背血管分支吻合。在解剖观察基础上 ,临床应用 12例 ,对各种原因所致的手部皮肤及深部组织缺损病例 ,设计尺动脉腕上皮支降支蒂前臂尺侧逆行皮瓣转位修复。皮瓣面积最大 15cm× 9cm ,最小 5cm× 8cm。　结果　尺动脉腕上皮支于豌豆骨上方约4cm处恒定起于尺动脉 ,起始处外径约 1 0～ 1 5mm ,主干长约 1 2cm ,于尺侧腕屈肌深面分出升支和降支。降支自腕上皮支分出下行 ,起始处外径约 1 0mm ,在腕背尺侧与桡动脉腕背支末端形成恒定的吻合。此外 ,尚有较浅层次的吻合支约 4～ 5支 ,分布于指伸肌腱浅面、小指展肌与小指伸肌腱之间。降支在行程中有较丰富的静脉血管网伴行。临床应用 12例 ,10例全部存活 ,2例皮瓣远端部分表皮坏死 ,经换药后愈合。术后经 6～ 12个月随访 ,皮瓣存活 ,血运良好。　结论　尺动脉腕上皮支降支与腕部血管网有丰富的吻合 ,以降支为蒂逆行供血设计皮瓣 ,血供可靠 ,蒂部更长 ,转位更加灵活 ,皮瓣转位可覆盖手部各种创面。Objective To study the anatomy basis of the distallical pedicled dorsoulnar forearm flap based on dorsal descending branch of the ulnar artery and to confirm the reliability of this flap in clinical application. Methods Twelve sides of upper extremities specimens injected with red latex and 8 sides with ink were used in the study. The origin, course, branches distributions anatomosis and the communication of the dorsal descending branch of the ulnar artery were dissected in detail. Casting specimens of arteries of the forearm on 5 sides were also observed. Basic this anatomy study, the reverse flap were designed and transferred to reconstruct 12 case hand soft tissue defects. The largest flap size were 15cm×9cm, the smallest was 5cm×8cm. Results The dorsal branch of the ulnar artery originates about 4cm proximal to the pisiform as a branch of the ulnar artey. After about 1.2cm of a common trunk, this branch divided into tow mainly branch-ascending and descending branches. The descending branch, with a diameter of about 1.0mm, connects with dorsal carpal arch. As the ulnar artery, the descending branch is accompanied by tow concomitant veins. All flaps survived on clinical applications. The results were satisfactory after 6 to 12 months follow-up. Conclusions There are very reach anastomose network in the dorsum of the wrist with the dorsal descending branch of the ulnar artery. Basic this anastomose network, the reverse flap can be designed for corvered hand soft tissue defects, so the arc of rotation of the flap would wider, the transferred operation would more flexible.

关 键 词：外科皮瓣 皮瓣移植 尺动脉 手外伤 解剖结构 

分 类 号：R622.1[医药卫生—整形外科]