CAJ | 학술논문

目的探讨拇指尺侧指背动脉为蒂虎口背侧逆行岛状皮瓣修复拇指皮肤缺损的手术方法.方法用70侧成人尸手标本,经动脉灌注红色乳胶,解剖观测拇指尺侧指背动脉的来源、走行和分布范围.在临床上应用该逆行岛状皮瓣修复8例拇指皮肤缺损,切取面积为4.5 cm×3.0cm～7.5 cm×4.0cm. 结果拇指尺侧指背动脉分为4种类型:Ⅰ型为肌外型,即该动脉起源于第1掌背动脉,走行在第1骨间背侧肌表面,占42.9％；Ⅱ型为肌内型,即该动脉起源于拇主要动脉或桡动脉深支,走行在第1骨间背侧肌深面,占41.4％；Ⅲ型为混合型,即该动脉起源于拇主要动脉与第1掌背动脉在第1掌指关节水平的吻合处,占11.4％；Ⅳ型为缺如型,占4.3％.临床应用8例皮瓣全部成活.术后平均随访8个月,皮瓣质地良好,外形满意,虎口功能正常. 结论拇指尺侧指背动脉变异较大,术中要探查该动脉的类型,以决定手术方法.该皮瓣手术操作简便,对供区影响小,是修复拇指皮肤缺损的理想皮瓣.
목적 탐토무지척측지배동맥위체호구배측역행도상피판수복무지피부결손적수술방법.방법 용70측성인시수표본,경동맥관주홍색유효,해부관측무지척측지배동맥적래원、주행화분포범위.재림상상응용해역행도상피판수복8례무지피부결손,절취면적위4.5 cm×3.0cm～7.5 cm×4.0cm. 결과 무지척측지배동맥분위4충류형:Ⅰ형위기외형,즉해동맥기원우제1장배동맥,주행재제1골간배측기표면,점42.9％；Ⅱ형위기내형,즉해동맥기원우무주요동맥혹뇨동맥심지,주행재제1골간배측기심면,점41.4％；Ⅲ형위혼합형,즉해동맥기원우무주요동맥여제1장배동맥재제1장지관절수평적문합처,점11.4％；Ⅳ형위결여형,점4.3％.림상응용8례피판전부성활.술후평균수방8개월,피판질지량호,외형만의,호구공능정상. 결론 무지척측지배동맥변이교대,술중요탐사해동맥적류형,이결정수술방법.해피판수술조작간편,대공구영향소,시수복무지피부결손적이상피판.
Objective To explore a surgical treatment of skin defects on the thumb by reverse-flow island flaps on dorsal thumb web with dorsoulnar artery of thumb as a pedicle.Methods The origin,courses and distribution of dorsoulnar artery of thumb from 70 adult cadaveric hand specimens perfused by red latex were explored.Skin defects on the thumb of 8 cases were repaired with reverse-flow island flaps on dorsal thumb web.The cut areas of flaps vary from 4.5 cm × 3.0 cm to 7.5 cm × 4.0 cm.Results There were 4 types of the dorsoulnar artery of thumb basing on the origin and courses.Type Ⅰ was outside the first dorsal interosseous muscle type,which was the dorsoulnar artery of thumb mainly originated from the first dorsal metacarpal artery and cross through the surface of the first dosal interosseous muscle(42.9％).Type Ⅱ was under the first dorsal interosseous muscle type,which was from the thumb principal artery or deep branch of radial artery and run under the first dorsal interosseous muscle(41.4％).Type Ⅲ was mixed type from the anastomose point of above two arteries at the level of the first metacarpophalangeal joint(11.4％).Type Ⅳ was absence type (4.3％).Eight flaps fully survived.Excellent texture and satisfying appearance of the flaps as well as normal thumb web function were verified after 8 months' follow-up.Conclusion It is significant to determine the type of dorsoulnar artery of thumb to decide different operations due to the artery's considerable variation.The reverse-flow island flap on dorsal thumb is an ideal method to repair soft tissue defect on the thumb for its convenient operating and little effect in the donor area.