上臂内侧皮瓣血管的解剖学研究(1)
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[摘要]目的：本研究旨在通过对上臂内侧皮瓣深筋膜浅层以上血管的解剖学研究，为临床应用上臂内侧扩张皮瓣提供理论指导。方法：新鲜成人上肢标本10侧，左右各半，乳胶灌注血管。四倍放大镜下由浅入深进行解剖，观察浅筋膜层内血管的吻合情况、吻合支的数量及皮动脉穿出深筋膜的位置。结果：上臂内侧自深筋膜浅层平面发出的皮动脉8～9支，各皮动脉于深筋膜浅层内发出分支沿纵行方向相互吻合。上臂皮瓣的中轴部位即内侧肌间隔区域吻合支最为丰富，其次为上臂内侧偏后部分。每侧肢体均有2～5支明显的贯串上臂全长的吻合支，多位于皮瓣的中部及偏后侧部位。皮动脉穿出点集中在臂内侧肌间隔区域，最远分支距肘横纹(3.47±1.50)cm，近端分支距腋窝横皱襞距离(1.64±1.22)cm。结论：上臂内侧皮瓣血供介于轴型皮瓣与任意型皮瓣之间，切取时长宽比例超过任意型皮瓣。皮瓣为双向供血，无论以近端为蒂还是以远端为蒂切取皮瓣均是安全的。以内侧肌间隔为轴线，沿深筋膜浅层设计顺行或逆行皮瓣血供均可靠，切取皮瓣安全，如需扩大切取皮瓣，向后扩展延伸比向前扩展血供更可靠。皮瓣制作时蒂部尽可能置于肌间隔区域，蒂宽约4cm。以近端为蒂时，扩张器剥离腔隙近端距腋窝横皱襞需超过3cm，远端为蒂时，扩张器剥离腔隙远端距肘横纹需超过5cm。
[关键词]上臂内侧皮瓣；血管解剖；扩张皮瓣
[中图分类号]R322 [文献标识码]A [文章编号]1008-6455(2012)01-0068-03
Anatomical study of the medial upper arm flap and clinical applications
LV Shu-zhen1，LI Yang-qun2，LI Yan-ping1,FENG Yu1
(1. Departmentof Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, 100038.2 .Department of Plastic Surgery, Plastic Surgery Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, 100144)
Abstract: Objective To investigate the blood supply of the expanded skin flap from medial upper arm. Methods Microsurgical anatomical study was carried out on10 fresh upper limbs of human cadavers, which had been injected with red and blue latex. The study was focused on the origin, numbers, position and vascular anastomosis of perforator artery (diameter≥0.30mm)origiated from brachial artery. Results 8～9 cutaneous arteries are gived off from brachial artery at the layer of the deep fascia,these branches which give off the ramus anastomoticus also tend to anastomose in the deep fascial,superficial fascia and subdermal level respectively,they shape the vascular network on the deep fascia,in the superficial fascia and subdermal level and are the main supplying vessels.More ramus anastomoticus are observed on the medial intermuscular septum ,and then posterior part of the arm.There are total 84 cutaneous artery perforators in 10 upper limbs,most of them locate at the medial intermuscular septum. Conclusions The blood supply of the medial upper arm flap is sufficient,branches of the cutaneus artery anastomose along the longitude direct of the intermusular septum,so the flap which is separated on the deep fascia along intermusular septum is safe,if larger flap is needed the flap can be extended to the posterior ......
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