摘要目的 对游离上臂外侧皮瓣作进一步应用解剖学研究,探讨皮瓣的改良制备方法,以使其更好地适应修复头颈部缺损的需求,为临床应用提供形态学的科学依据.方法 游离上臂外侧皮瓣的传统制备方法是在三角肌止点处以桡侧副动静脉下段为皮瓣血管蒂,而其改良制备方法则是以肱深动、静脉为皮瓣的血管蒂.本组采用22侧经颈总动脉灌注红色乳胶的中国人成人上肢湿标本,男女不限.观察并比较标本肱深动静脉、桡侧副动静脉、后桡侧副动静脉及其皮支和臂下外侧皮神经的起点、行程、分支、分布范围、变异情况,以及上述血管的外径、血管蒂长度.结果 传统游离上臂外侧皮瓣制备方法所测得皮瓣的平均血管蒂长度(-x±s)为(5.46±2.60) cm,动脉外径为(1.15±0.21) mm,静脉外径为(1.26±0.23)mm.改良游离上臂外侧皮瓣的制备方法所测得皮瓣的血管蒂长度为(14.85±1.28) cm,动脉外径为(2.24 ±0.66)mm,静脉外径为(2.22±0.52)mm.改良皮瓣与传统皮瓣的血管蒂动、静脉外径和长度差异均有统计学意义(t值分别为-8.483,-8.690和-15.057,P值均＜0.01).结论 改良游离上臂外侧皮瓣的制备方法可使游离上臂外侧皮瓣的血管蒂延长、管径增粗,更加适宜修复头颈部中小型缺损.

abstractsObjective To study the anatomy and preparation methods of an improved lateral arm free flap (LAFF) for the future clinical application.Methods Twenty-two adult upper extremities from cadavers after injected with red latex through common carotid arteries were used.The course,branches,distribution and variations of the blood vessels and nerves of the improved LAFF were observed.The outer diameters of the vessels were measured.Results The mean length of vascular pedicle of the improved LAFF was (14.85 ± 1.28) cm,significantly more than that (5.46 ± 2.60) of traditional LAFF (t =-8.483,P ＜0.001).The mean outer diameters of pedicle arteries and veins in the improved LAFF were (2.24 ±0.66) mm and (2.22 ±0.52) mm,significantly more than those (1.15 ±0.21 and 1.26 ±0.23)in traditional LAFF (t =-8.690,P ＜ 0.001 ; t =-15.057,P ＜ 0.001),respectively.Conclusion The improved LAFF has a longer vascular pedicle and larger artery and vein in diameter than conventional LAFF,and is more suitable for the repair of the small and medium-sized defects of the head and neck.