摘要
目的 :研究前臂链式血供远端蒂筋膜组织瓣的解剖特点及其在手外科的临床应用。 方法 :通过 14具新鲜前臂标本的血管灌注与显微解剖 ,观察了前臂筋膜皮肤的血供特点 ,并以此为基础设计远端蒂岛状筋膜皮瓣和筋膜皮下组织瓣 ,修复手部创伤缺损 2 4例。结果 :前臂桡侧筋膜皮肤的血供来自桡动脉发出的数目众多的细小肌间隙穿动脉 ,这些穿动脉在深筋膜表面和浅筋膜的皮神经、皮静脉周围 ,形成环环相扣的纵向链式吻合血管丛。临床以桡骨茎突上 1.5～ 2 .0 cm为旋转轴点 ,设计不带桡动脉的远端蒂岛状筋膜皮瓣 ( 15例 )和筋膜皮下组织瓣 ( 9例 )修复手部皮肤缺损或进行软组织重建 ,组织瓣面积( 9 cm× 4cm)～ ( 18cm× 5 cm) ,长宽比例 ( 2 .7～ 5 .1)∶ 1,均完全成活。 结论 :链式血供远端蒂筋膜组织瓣修复手部创伤缺损 ,方法简单 ,效果可靠。在某些情况下可以代替带知名动脉的逆行岛状皮瓣 。
Objective: To study the distally based radial forearm fasciocutaneous and adipofascial flaps, the concept of chain linked vascularization and clinical experiences in hand surgery. Methods: Fourteen fresh cadaver forearms were injected and dissected. Twenty four distally based radial forearm flaps without radial artery were used for hand coverage and soft tissue reconstruction. Results: The vascularization of radial forearm integument was supplied by numerous tiny septo fasciocutaneous perforators issuing from the radial artery. The branches of these perforators anastomosed with each other, formed an abundant chain linked longitudinal vascular plexus on the surface of deep fascia and around the cutaneous nerves and/or cutaneous veins. Based on those anatomic findings, distally based island fasciocutaneous flaps (15) and adipofascial flaps (9) without the deep radial artery were successfully elevated in 24 patients. The pivot point of pedicle was about 1.5 to 2 cm above the radial styloid process. The size of flap ranged from (9 cm×4 cm) to (18 cm×5 cm), with a length to width ratio of (2.7 5.1)∶1. Conclusion: Distally based radial forearm flap with chain linked vascularization is a simple, reliable and effective alternative for hand coverage and soft tissue reconstruction. It can often obviate the need for classic radial artery reverse flow island flap or even a free flap.
出处
《第二军医大学学报》
CAS
CSCD
北大核心
2000年第7期693-696,共4页
Academic Journal of Second Military Medical University
基金
国家自然科学基金资助项目 !( 392 0 0 14 9)
关键词
手部缺损
前臂桡侧远端蒂皮瓣
岛状筋膜皮瓣
forearm
hand
fasciocutaneous flap
adipofascial flap
distally based flap
neurocutaneous flap
island flap
