MICROSURGICAL ANATOMY OF THE SKIN FLAP OF LATERAL BRACHIUM / 解剖学报

The arterial source of the flap,the anastomoses of cutaneous arteries in theskin and subcutaneous tissue and nervous distribution in the flap were observed andsurveyed in 42 upper limbs of adult cadavers.1.The arterial source of the flap comes mainly from the cutaneous branches ofprofund brachial artery,radial collateral artery,lateral humeral cutaneous artery andcutaneous branches of the posterior circumflex humeral artery.In most cases theprofund brachial artery and radial collateral artery may be served as the vascularpedicle of the flap of lateral brachium in transplantation.2.The cutaneous arteries in this flap anastomose each other to from a networkin the skin and subcutaneous tissue.Cutaneous arteries arising from the medial brac-hial region and the upper part of forearm also participate in the formation of thisvascular network.3.The veins of the flap contain both superficial and deep groups:The superfi-cial group is the cephalic vein of brachium which goes upward along the lateralsulcus of m.biceps brachii and its outer caliber is somewhat wider;the deep groupfollows the profund brachial artery or radial collateral artery as their venae comit-antes.Both groups may be sutured together or separately with veins of the recipientin skin grafting.4.The lateral brachial cutaneous nerve and posterior antebrachial cutaneousnerve pierce through the lateral intermuscular septum at various levels,and innervateover the skin in lateral brachial and posterior forearm regions.Since the posteriorbrachial cutaneous nerve is accompanied closely by the radial collateral artery,muchattention should be paid to it in cutting skin flap.5.The extent of cutting a skin flap in lateral brachial region can be enlargeddue to free anastomoses with arteries of adjacent regions which was demonstrated byperfusing red ink into profund brachial artery.The flap of lateral brachium maybe subdivided into following three parts:the upper,middle and lower,the vascularpedicle of which are the cutaneous branch of posterior circumflex humeral artery,lateral humeral cutaneous artery and profund brachial artery(or radial collateralartery)respectively.

VASCULAR STUDY ON SKIN FLAP OF FOREARM / 解剖学报

The cutaneous arteries of the forearm and their anastomoses in skin and subcutaneous tissue were invetigated on 35 upper limbs.1. The average length of the radial artery is 215.3 mm. This artery can be divided into a covered part and a exposed part. Their lengths are 117.7 mm. and 101.4 mm. respectively. The calibers of the upper end, the intermediate point, and the lower end of the radial artery are 2.7mm, 2.3 mm and 2.4 mm respectively.2. The exposed part of the radial artery sends out more cutaneous branches (9.6 branches) than the covered part (4.2 branches), While their muscular branches are nearly equal in number. The calibers of the cutaneous and muscular branches of the radial artery varies from 0.3～0.5 mm.The fine anastomoses of the cutaneous branches exist between the radial and ulnar arteries and between the radial and ulnar arteries and the dorsal interosseus artery and they form an arterial networks in the subcutaneous tissue of the whole forearm. For blood supply a skin flap may be cut from the whole forearm from the standpoint of morphology.4. The calibers of the radial and cephalic veins at the level of middle part of the forearm are 1.3 mm and 2.8 mm respectively. As the vasular pedicle both the veins should be anastomosed during transplant operation in order to increase the volume of the draining blood.5. The skin flap of forearm blongs to a type of blood supply of arterial trunk network, which have been distinguished with that of some other skin and myocutaneous flaps according to the anatomical characteristics of the radial artery.

VASCULARIZATION OF THE TENSOR FASCIA LATA MYOCUTANEOUS FREE FLAP / 解剖学报

1. The blood supply of the tensor fascia lata myocutaneous free flap comes chiefly from the ascending branch of the lateral circumflex artery (76.74％) or its ascending and the transverse branches (23.26％). In most cases the ascending branch may be served as the vascular pedicle of myocutaneous free flap in transplatation. In a few cases the transverse branch my be used instead of the ascending one.2. The projection of the origin of the lateral circumflx artery on the body surface is at a point averaging 96.5mm below, and 49.2mm medial to the anterior superior iliac spine. This point is the surface landmark of the lateral circumflex artery. 3. The branches of the lateral circumflex artery may be classified into four types. Type 1—32 cases, 74.42％; Type Ⅱ—3 cases, 6.98％; Type Ⅲ—7 cases, 16.28％; Type Ⅳ—1 cases, 2.33％.4. The tensor fascia lata is chiefly supplied by the ascending branch of the lateral circumflex artery, it divides into a short superior and a long inferior twigs. Both twigs enter the muscle and form abundant anastomoses in the subcutaneus tissues. In order to reduce the thick ness of the free flap for the use in plastics, the superior twig with its supplying muscle is cut away and the inferior one's left to supply myocutaneus flap.5. The angle between the ascending branch and the inner surface of the tensor fasca lata varies between 44? to 120?, with an average of 66.5?. The original angle must be kept in transplantation, which favours the survival of the myocutaneus free flap.