摘要
目的探讨肘窝穿支的形态学特征,为肘窝穿支蒂V-Y推进皮瓣修复肘前皮肤软组织缺损提供解剖学基础。方法选用30侧体积分数10%甲醛常规防腐固定的成人上肢标本,通过乳胶灌注、巨微解剖、摹拟手术等方法,手术放大镜下重点观测:①肘窝的形态;②肘窝动脉穿支的起源、分支与分布特点;③肘窝动脉穿支与邻近血管网的吻合。结果①肘窝为肘部前面的三角形凹陷,系前臂血管神经通行的门户。②肘窝前面皮肤血供多源性由肱动脉及其分支发出的穿支供养,穿支变异较大,据其数目和大小分为3型:A.粗大集中型(肘下动脉):穿支1支者,外径0.6~1.2 mm,占43.33%(13侧);B.细小分散型:穿支3~4支者,外径0.3~0.6 mm,占36.67%(11侧);C.适中均衡型:穿支2支者,外径0.4~0.7 mm,占20.00%(6侧);③穿支沿前臂外侧皮神经/头静脉两侧浅出深筋膜至肘前皮肤,分支在浅筋膜内彼此相互间、邻近血管间均吻合沟通形成肘窝筋膜血管网。结论以肘窝动脉穿支为蒂,可形成V-Y推进皮瓣修复肘关节邻近软组织缺损。
Objective To investigate the morphological characteristics of the cubital fossa perforators,providing anatomical basis for restoring the antecubital defects by using the V-Y advancement flap based on the cubital fossa perforators.Methods 30 sides of adult cadaveric upper extremities were collected to perform red latex perfusion,macro-micro-anatomy,and mimic operation.The following contents were observed under a surgical magnifier:①The morphology of the cubital fossa;②The origin,branches,and distribution of the cubital fossa perforators.③The anastomosis of the cubital fossa perforators and the peripheral rete vasculosum.Results①The cubital fossa was a triangle lacuna in the anterior aspect of the elbow,which was a passing portal for antebrachial vessels and nerves.②The blood supply for the skin of the cubital fossa was multi-source,which was commonly composed of the brachial artery and the perforators from the branches of the brachial artery.The perforators had a large variation and could be classified into three types according to the number and outer diameter:A.Thick and concentrated type(13/30,accounting for43.33%):this type had 1 perforator(inferior cubital artery)with an average outer diameter of 0.6~1.2 mm.B.Tiny and dispersive type(11/30,accounting for 36.67%):this type had 3~4 perforators with an average outer diameter of 0.3~0.6 mm;C.Moderate and balanced type(6/30,accounting for 20%):this type had 2 perforators with an average outer diameter of 0.4~0.7 mm;③The perforators punctured out of the deep fascia along either side of the cutaneous antebrachial lateralis nerve or cephalic vein towards the antecubital skin,which also anastomosed with each other and with adjacent vessels to form the fascial vascular network of cubital fossa.Conclusions The V-Y advancement flap based on the cubital fossa perforators could become a good supplement for restoring the antecubital defects.
作者
胡德庆
周晓
陈鹏
张文明
HU De-qing;ZHOU Xiao;CHEN Peng;ZHANG Wen-ming(Department of Orthopedics,The First Affiliated Hospital of Fujian Medical University,Fuzhou,350005,China;Department of Hand Surgery,Jiangsu Wuxi Ninth People Hospital,Wuxi 214062,China)
出处
《中国临床解剖学杂志》
CSCD
北大核心
2020年第2期131-134,共4页
Chinese Journal of Clinical Anatomy
基金
福建省自然科学基金资助(2017J05122)。
关键词
肘窝
穿支皮瓣
推进皮瓣
肘前缺损
Cubital fossa
Perforator flap
Advancement flap
Antecubital defect
作者简介
胡德庆(1987-),主治医师,博士,研究方向:骨、关节、软组织损伤与修复,Tel:18050348001,E-mail:hudeqing1987@126.com;通讯作者:陈鹏,E-mail:chenpengfygk@163.com。
