中国临床解剖学杂志 ›› 2010, Vol. 28 ›› Issue (4): 358-.

• 应用解剖 • 上一篇    下一篇

前臂后外侧中段穿支蒂皮神经营养血管皮瓣的应用解剖

郑和平1, 陈 鹏2, 洪发兰2, 陈超勇1, 张发惠1   

  1. 1.南京军区福州总医院军区骨科研究所,福建医科大学福总临床医学院,  福州   350025;
    ⒉福建医科大学附属第一医院骨科,  福州   350004
  • 收稿日期:2010-01-25 出版日期:2010-07-25 发布日期:2010-07-27
  • 作者简介:郑和平(1962-),安徽池州人,男,副教授,主任医师,主要从事临床解剖学研究,Tel:(0591)24937085
  • 基金资助:

    2010-01-25

Applied anatomy of neurocutaneous vascular flap pedicled with posterolateral mid-forearm perforators

ZHENG He-ping*,CHEN Peng,HONG Fa-lan,et al.   

  1. *Laboratory of Clinical Anatomical Research Center of Military Area Command in Fuzhou General Hospital of Military Area Command of Chinese PLA,Fujian 350025,China
  • Received:2010-01-25 Online:2010-07-25 Published:2010-07-27

摘要:

目的 为前臂后外侧中段穿支蒂皮神经营养血管皮瓣提供解剖学基础。 方法 在30侧动脉内灌注红色乳胶的成人上肢标本上解剖观测:①前臂后皮神经走行与分布;②前臂后外侧中段穿支与前臂后皮神经营养血管间的吻合关系。另在1侧新鲜标本上进行摹拟手术设计。 结果 ①前臂后皮神经主干行于前臂背侧,约在指伸肌与尺侧腕伸肌之间下行达腕背部,分布于前臂后外侧1/3区域;②营养血管为多节段、多源性,其中前臂后外侧中段穿支的位置相对恒定,在指伸肌与桡侧腕短伸肌的肌间隙、旋后肌与拇长展肌之间(肱骨外上髁下12.5~15.8 cm范围内)穿过深筋膜至皮下,并分出众多的细小血管与前臂后皮神经的神经旁和神经干血管链的分支密切吻合,在指伸肌与桡侧腕短伸肌之间形成顺沿肌间隙和前臂后皮神经纵轴的血管丛。 结论 可以前臂后外侧中段穿支为蒂形成皮神经营养血管皮瓣转位修复前臂、腕部软组织缺损。

关键词: 前臂损伤, 穿支, 外科皮瓣, 前臂后外侧, 移位术

Abstract:

Objective To provide anatomical basis for the neurocutaneous vascular flap pedicled with posterolateral mid-forearm perforators. Methods 30 embalmed upper limbs of adult cadavers perfused with red latex were used for this anatomical study, and the followings were observed :①The course and distribution of the posterior antebrachial cutaneous nerve;②Anastomoses between posterolateral mid-forearm perforators and nutrient vessels of the antebrachial cutaneous nerve. Mimic operation was performed on one side of fresh specimen. Results ①The trunk of posterior antebrachial cutaneous nerve run on the dorsal forearm,descending to the wrist between the extensor digitorum and extensor carpi ulnaris, and innervated about 1/3 area of the posterolateral forearm. ②the nutrient vessels were made up by segmental perforators of multiple origins. The posterolateral mid-forearm perforators whose locations were relatively constant travelled in the intermuscular septum between the extensor digitorum and extensor carpi radialis brevis or the supinator and abductor pollicis longus , and pieced the deep fascia to the subcutaneous tissue (range: 12.5 ~ 15.8 cm below the lateral condyle of humerus). A large number of small arterial branches were given off by those perforators, which anastomosed with the perineural and intraneural nutrient-vessel links of the antebrachial cutaneous nerve, forming a longitudinal vascular plexus along the intermuscular septum between the extensor digitorum and extensor carpi radialis brevis and around the anterbrachial cutaneous nerve. Conclusions  The neurocutaneous vascular flap pedicled with posterolateral mid-forearm perforators can be developed to repair soft tissue defects of the forearm and wrist.

Key words: Forearm injuries, Perforating branches, Surgical flap, Posterolateral forearm, Transposition

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