指动脉背侧支皮瓣的解剖学基础及临床应用
The flap based on the dorsal branch of the digital artery: anatomy and clinical application
目的 探讨指动脉背侧支皮瓣血管解剖学基础及临床应用经验。 方法 5侧成人新鲜上肢标本经动脉红色乳胶灌注并解剖,观察指动脉背侧支的起始处外径,走行距离及吻合支情况。1侧成人新鲜上肢标本经氧化铅灌注,分别于灌注后2、4h行X线片摄影,观察指动脉背侧支走行、分布情况。临床上设计切取以指动脉背侧支为蒂的游离皮瓣修复指腹皮肤软组织缺损共6例6指。 结果 指动脉背侧支发出部位比较恒定,分别在近节指中段、近节中远1/3、中节中段及远指间关节平面,其中以近节中远1/3处的皮支发出最为恒定,起始处外径约为0.2mm。临床设计游离皮瓣6例6块修复指腹软组织缺损,皮瓣全部成活。术后随访6~18月(平均12月),皮瓣血运、质地、弹性良好,外形美观,感觉恢复S3,对供区损伤小。 结论 指动脉背侧支解剖恒定,供血可靠,以指动脉背侧支为蒂的游离皮瓣修复指腹创面是一种理想的方法,临床上可依具体情况选择来修复。
Objective To investigate blood supply features of the flap based on the dorsal branch of the digital artery and summarize clinical experience. Methods 5 fresh adult upper limb specimens were injected with red latex via artery and were dissected. The origin outer diameter, the course and anastomosis of the dorsal branch of the digital artery were measured and observed. Distribution features of dorsal branch of the digital artery was further explored on X-ray images collected from one fresh adult upper limb specimen injected with lead oxide. Free flaps of dorsal branch of the digital artery were used to repair soft tissue defects of finger pulp (6 fingers of 6 patients). Results The origin of the dorsal branch of the digital artery was relatively constant, and respectively located at the middle of proximal phalanx, the middle distal 1/3 of proximal phalanx, the middle of second phalanx and the distal of interphalangeal joints. Among them, the origin branch in the middle distal 1/3 of proximal phalanx was constant, with the outer diameter of 0.2mm. 6 to 18 months' follow-up proved that, 6 flaps survived well, with good blood supply, texture, flexibility and appearance. The sensory recovery reached S3 level. Conclusions The dorsal branch of the digital artery is less variant. It is an ideal selection for prepare free flaps to repair soft tissue defect of finger pulp.
  / 指固有动脉 / 背侧支 / 外科皮瓣 / 修复重建
The digital artery / Dorsal branch / Surgical flap / Repair and reconstruction surgery
[1] 袁新文,巨积辉,蒋国栋,等.微型皮瓣修复手指指腹缺损
[J].中国美容医学,2012,21(2):205-208.
[2] 侯书健,程国良,方光荣,等.急诊修复拇指指腹缺损三种方法的研究
[J].中华手外科杂志,2002,18(3):153-154.
[3] 程国良.手部皮肤覆盖原则与趋向
[J].中华手外科杂志,2006,22(5):257-258.
[4] 王海文,侯瑞兴.微型皮瓣修复手指皮肤软组织缺损
[J].中华手外科杂志,2006,22(5):273-275.
[5] 侯瑞兴,巨积辉,赵强,等.游离第二趾胫侧皮瓣修复手指指腹缺损
[J].中华手外科杂志,2008,24(4):226-228.
[6] Del-Pinal,F Garcia-Bernal,FJ Regalado,et al.The tibial second toe vascularized neurocutaneous free flap for major digitalnerve defects
[J].J Hand Surg,2007,32A(3):209-217.
[7] 胡鸿泰.指动脉终末背侧支逆行皮瓣
[J].中华手外科杂志,2003,l9(1):31-32.
[8] 谢松林,唐举玉,陶克奇,等.指固有动脉背侧支为蒂的逆行掌指背筋膜皮瓣的应用解剖
[J].中国临床解剖学杂志,2010,28(1):97-99.
[9] Bakhach J,Martin D,Baudet J.Ulnar parametacarpal flap.Experience with 10 clinical cases.Annales de Chirurgie Plastique et Esthétique,1996,41(4):269-276.
[10] 田德虎,张英泽,赵民,等.指动脉背侧支逆行岛状皮瓣修复手指皮肤缺损
[J].中华创伤骨科杂志,2004,6(11):1309-1310.
[11] 赵民,邵新中,田德虎,等.指动脉背侧支逆行筋膜蒂岛状皮瓣修复手指皮肤缺损
[J].中国修复重建外科杂志,2005,19(6):453-454.
/
〈 |
|
〉 |