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1、上臂内侧皮瓣血管解剖学探究［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
2、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襲距离(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嬖需超过3cm,远端为蒂时，扩张器剥离腔隙远端距肘横纹需超过5c
3、m。［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)01-0068-03AnatomicalstudyofthemedialupperarmflapandclinicalapplicationsLVShu-zhen1丄IYang-qun2,LIYan-ping1,FENGYu1(1.DepartmentofBreastSurgery,BeijingShijitanHospital,CapitalMedicalUniversity,Beijing,100038.2.Depart
4、mentofPlasticSurgery,PlasticSurgeryHospital,PekingUnionMedicalCollege,ChineseAcademyofMedicalScience,Beijing,100144)Abstract:ObjectiveToinvestigatethebloodsupplyoftheexpandedskinflapfrommedialupperarm.MethodsMicrosurgicalanatomicalstudywascarriedouton10freshupperlimbsofhumanca
5、davers,whichhadbeeninjectedwithredandbluelatex・Thestudywasfocusedontheorigin,numbers,positionandvascularanastomosisofperforatorartery(diameter>0.30mm)origiatedfrombrachialartery.Results8~9cutaneousarteriesaregivedofffrombrachialarteryatthelayerofthedeepfascia,thesebrancheswhic
6、hgiveofftheramusanastomoticusalsotendtoanastomoseinthedeepfascial,superficialfasciaandsubdermallevelrespectively,theyshapethevascularnetworkonthedeepfasciajnthesuperficialfasciaandsubdermallevelandarethemainsupplyingvessels.Moreramusanastomoticusareobservedonthemedialintermusc
7、ularseptum,andthenposteriorpartofthearm.Therearetotal84cutaneousarteryperforatorsin10upperlimbs,mostofthemlocateatthemedialintermuscularseptum・ConelusionsThebloodsupplyofthemedialupperarmflapissufficient,branchesofthecutaneusarteryanastomosealongthelongitudedirectoftheintermus
8、ularseptum,sotheflapwhichisseparatedonthedeepfasciaalonginter
