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)01-0068-03AnatomicalstudyofthemedialupperarmflapandclinicalapplicationsLVShu-zhen1丄IYang-qun2,LIYan-ping1,FENGYu1(1.DepartmentofBreastSurgery,BeijingShijitanHospital,CapitalMedicalUniversity,Beijing,100038.2.DepartmentofPlasticSurgery,PlasticSurgeryHospital,PekingUnionMedicalCollege,ChineseAcademyofMedicalScience,Beijing,100144)Abstract:ObjectiveToinvestigatethebloodsupplyoftheexpandedskinflapfrommedialupperarm.MethodsMicrosurgicalanatomicalstudywascarriedouton10freshupperlimbsofhumancadavers,whichhadbeeninjectedwithredandbluelatex・Thestudywasfocusedontheorigin,numbers,positionandvascularanastomosisofperforatorartery(diameter>0.30mm)origiatedfrombrachialartery.Results8~9cutaneousarteriesaregivedofffrombrachialarteryatthelayerofthedeepfascia,thesebrancheswhichgiveofftheramusanastomoticusalsotendtoanastomoseinthedeepfascial,superficialfasciaandsubdermallevelrespectively,theyshapethevascularnetworkonthedeepfasciajnthesuperficialfasciaandsubdermallevelandarethemainsupplyingvessels.Moreramusanastomoticusareobservedonthemedialintermuscularseptum,andthenposteriorpartofthearm.Therearetotal84cutaneousarteryperforatorsin10upperlimbs,mostofthemlocateatthemedialintermuscularseptum・ConelusionsThebloodsupplyofthemedialupperarmflapissufficient,branchesofthecutaneusarteryanastomosealongthelongitudedirectoftheintermusularseptum,sotheflapwhichisseparatedonthedeepfasciaalongintermusularseptumissafe,iflargerflapisneededtheflapcanbeextendedtotheposterior.lntermusularseptumisthebetterpositionofthepedicle.Keywords:medialupperarmflap;vascularanatomy;expandedflap上臂内侧皮瓣因其独特的优点，是修复头面部、腋窝、肘部、手部等处缺损的常用方法之一。早在1597年Tagliacozzi就描述过应用上臂内侧皮瓣进行鼻再造和面部修复的手术。而上臂内侧扩张皮瓣因对供区损伤小，经过扩张后，可供切取的皮瓣面积大，皮瓣厚度更适合于面颈部、鼻部的修复等优点，临床极具应用前景。李养群等口］,钱利等［2］应用上臂内侧扩张皮瓣修复面颈部瘢痕挛缩，周传德等［3］应用上臂内侧远位蒂扩张皮瓣治疗头面部瘢痕，于丽，王佳琦等［4］应用扩张后的上臂内侧逆行皮瓣带蒂转移修复大面积面部瘢痕挛缩合并鼻缺损均取得良好效果。本文通过对上臂内侧深筋膜浅层以上的血管进行解剖，对穿出的皮动脉及其分支进行解剖分析，对...