摘要
目的观察前臂后外侧中段穿支皮瓣的解剖学。方法在30侧动脉内灌注红色乳胶的成人上肢标本上，以肱骨外上髁为观测标志点，手术放大镜下重点解剖观测：（1）前臂后外侧中段穿支的起源、分支与分布；（2）穿支与周围血管间吻合关系。另在2侧新鲜标本上分别进行墨染和模拟手术设计。结果来源于骨问后动脉桡侧肌皮支、桡动脉肌间隙支和桡动脉直接骨膜支的前臂后外侧中段穿支，穿出深筋膜的位置相对恒定，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—15．8cm范围内穿过深筋膜至皮下，并分出众多的细小血管与邻近的肌皮穿支血管、前臂后皮神经外侧支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外侧支纵轴的血管丛。结论以前臂后外侧中段穿支为蒂，可形成轴型皮瓣或跨区域供血皮瓣转位修复前臂及腕部软组织缺损。
Objective To observe the anatomy of the perforator flap of the posterolateral midforearm. Methods Lateral condyle of the humerus was taken as the observation mark on 30 specimens of adult upper limb perfused with red latex. The surgical magnifier was used to observe the origin, branches and distribution of the perforating branches of the posterolateral midforearm as well as alanastomosis between perforating branches and peripheral vessels. Mimic operation was performed on the two sides of the fresh specimen. Results The perforating branches of the posterolateral midforearm originated from the radial musculoculancous branches of the posterior interosseous artery, the interumscular branches of the radial artery and the direct periosteal branch of the radial artery had relatively stable location of piercing the deep fascia. Then, the perforating branches of the posterolateral midforearm passed through the deep fascia to the subcutaneous part among the spatium intermusculare of extensor digitorum and extensor carpi radialis brevis, supinator and abductor pollieis longus （ within 12.5-15.8cm below the lateral condyle of the humerus）. Large number of small blood vessels were also separated and closely aligned with the musculoculancous branches vascular, peiineural and neural stem vascular chain of lateral branches of posterior antebraehial cutaneous nerve. Then, the vascular plexus was formed along the spatium intermusculare and lateral branches of posterior antebrachial cutaneous nerve longitudinal axis between extensor digitorum and extensor carpi radialis brevis. Conclusion The axial pattern flaps or cross-regional blood supply skin flap pedicled with the perforating branches of the posterolateral midforearm can be formed to repair the soft tissue defect of the forearm and wrist.
出处
《中华创伤杂志》
CAS
CSCD
北大核心
2011年第3期228-231,共4页
Chinese Journal of Trauma
基金
福建省自然科学基金资助项目（2009J01183）
关键词
前臂损伤
外科皮瓣
穿支
Forearm injuries
Surgical flaps
Perforating branches
