摘要
目的 探讨含指掌侧固有神经背侧支的指背岛状皮瓣的应用解剖学,以提高皮瓣的修复疗效。方法 在20具40侧成人上肢标本上解剖观测指掌侧固有神经背侧支的起点和走行。另对4具8侧成人上肢进行血管铸型制作,观察指掌侧固有动脉及手指静脉的分布范围。结果 示、中、环指的指掌侧固有神经在掌指关节附近恒定发出1较大的背侧支,小指尺侧未见背侧支出现;小指桡侧背侧支缺如者占82.5％。指掌侧固有神经背侧支在近节指骨中下1/3处恒定地和指掌侧固有动脉相交,在该处神经跨过动脉上方的占69.17％,另30.83％走行在动脉下方。结论 示、中、环指的背侧支有较为恒定的蒂部,可以包含在指背侧岛状皮瓣中。其体表投影为近节指骨基底掌侧部中外1/3至近侧指间关节背外侧,以及其和甲根外侧缘的连线。小指桡侧的指掌侧固有神经背侧支缺如率较高,不宜设计成背侧支指背皮瓣。
Objective To investigate the applied anatomy of dorsal digital island flap with the dorsal sensory nerves and to improve its treatment outcome. Methods Upper limbs of 20 (40 sides) adult embalmed cadavers were dissected under unaided eyes and an operating microscope at magnification of x4 to observe and measure the origination and course of the dorsal branch of proper palmar digital nerve (PPDN) . Vessel emplastic fabrication was used to upper limbs of other four adults to reveal the distributing area of proper palmar digital artery (PPDA) and dorsal digital veins. Results The dorsal branches of the PPDN were constantly seen originating about the metacarpophalangeal joint on both sides of the index, middle and ring fingers. The dorsal branches on the ulnar side of the little finger were not found, while the absence rate of those on the radial side of the little finger was 82.5% . As a result of observation, 69.17% of dorsal branches strided over PPDA in the inferior 1/3 site of the proximal phalanx. The others tracked under arteries. Conclusion The source of dorsal branches of index, middle and ring fingers on both sides were invariable. These can be harvested with the reverse dorsal digital island flap to repair finger pulp defect. The line between the middle-lateral 1/3 site of proximal phalanx's volar base and the dorsal-lateral site of the proximal interphalangeal joint then connected with nail bottom can be looked as the projection on body surface of the dorsal branch. However, for the absence rate of the dorsal branches on the radial side of the little finger is so high, it should not be included in the dorsal digital island flap.
出处
《中华手外科杂志》
CSCD
2003年第4期208-210,共3页
Chinese Journal of Hand Surgery
基金
广东省科技公关项目(99806703G)
安徽省教育厅自然科学研究项目(2002KJ216)
