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1、·44·CHINESEJOURNALOFCLINICALANATOMYVOL.21NO.12003·应用解剖·拇指背尺侧逆行岛状皮瓣的应用解剖12211何葆华,朱,周吉林,严晟,叶坡(1.杭州市整形医院整形外科,浙江杭州310014;2.浙江大学医学院解剖学教研室;浙江杭州310006)【摘要】目的:报道拇指背尺侧逆行岛状皮瓣的解剖学基础和手术方法。方法:21只新鲜尸体手标本分别血管灌注染料解剖及动脉铸型标本对照观察,7个拇指背尺侧皮肤组织学切片检查。结果:(1)拇指背尺侧动脉在甲襞近侧与甲襞动脉弓
2、相吻合,又在拇指近节指骨颈水平通过穿支与拇指掌侧动脉吻合,并与拇指背尺侧皮神经呈节段伴行;拇指背尺侧动脉又通过“微小血管吻合”连接第1掌骨背处尺侧皮神经旁血管。(2)拇指背尺侧动脉无紧密伴行的静脉。结论:Bertelli的“拇指背尺侧(带)皮神经岛状皮瓣”和Brunelli的“拇指背尺侧皮瓣”均以拇指背尺侧动脉逆向供血,静脉回流赖以拇指背浅静脉及指深静脉逆向返流,但前者是后者的拓展。【关键词】拇指;背侧;岛状皮瓣;应用解剖【中图分类号】R323.71;R616.2【文献标识码】A【文章编号】1001
3、-165X(2003)01-0044-03Appliedanatomyofthereverseislandflapindorsoulnarthumb3HEBao2hua,ZHUXi,ZHOUJi2lin,etal.3DepartmentofPlasticSurgery,HangzhouPlasticSurgeryHospital,Hangzhou310014,China【Abstract】Objective:Toreporttheanatomicalbasisandoperatingmethodfo
4、rthereverseislandflapindorsoulnarthumb.Methods:Twenty2onefreshcadaverichandspecimenswereobservedaftervasculardyestuffperfusionandarterialcasting.SevenspecimensofskinindorsoulnarthumbwereunderwentHEstainingforhis2tologicaltest.Results:(1)Thedorsoulnarar
5、teryofthumbwasderivedfromprincipalarteryandanastomosedwiththepalmararteriesofthumbatthedorsalarcadeoftheproximalnailfoldandatthelevelofthefirstpha2lanxneck,collateralledwithdorsoulnarcutaneousnerve.Furthermore,thedorsoulnararteryofthumblinkedwiththeves
6、slesbesidetheulnarcutaneousnerveofthethumbby“microvascularanastomosis”.(2)Thedorsoul2nararteryofthumbhadnoclosedveinstoaccompanywith.Conclusion:BothBertlli’sdorsoulnarislandcuta2neousflapofthumbandBrunelli’sdorsoulnarflapofthumbarereverselysuppliedbyth
7、edorsoulnararteryofthumbandvenousbloodflowsbackthroughsuperficialanddeepveinsatthumbdorsum.Buttheformerhasbeendevelopedforthelatter.【Keywords】thumb;dorsum;islandflap;appliedanatomy有关拇指背尺侧逆行岛状皮瓣Bertelli(1992)首拇主要动脉在穿出第1骨间肌处发出一支拇指背先报道“逆行(带)皮神经岛状皮瓣”(rever
8、seneurocuta2尺侧动脉,外径0.3～0.9mm。本组8只墨汁灌注解[1]neousislandflap),此后,Brunelli(1999)又报道了“拇剖标本仅1只例外,其由桡动脉腕背段主干经第1骨指背尺侧皮瓣”(dorsoulnarflapofthethumb)是以拇间背侧肌浅面直接发出(图1,2)。拇指背尺侧动脉较主要动脉发出的拇指背尺侧动脉逆行供血的岛状皮为恒定,位于拇指背面的尺侧,由第1掌骨颈下行至近[2]瓣。两者关系如何?未见报道。作者通过对21只
