Distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve- basilic vein for repairing the hand defect

Yanfeng ZHUANG; Fahui ZHANG; Guodong ZHANG

ABSTRACT

BACKGROUND:

Flap pedicled with nutritional vessels of the cutaneous antebrachial medialis nerve is beneficial for repairing injury of dorsum of hand; but it needs the support from systemic anatomic research on distally based compound flap.

OBJECTIVE:

To study the anatomic theory of the distally based compound flap pedicled with nutrient vessels of the cutaneous antebrachial medialis nerve -basilic vein.

DESIGN:

Single sample observation.

SETTING:

Research Center for Clinical Anatomy, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA.MATERIALS The experiment was carried out at the laboratory for Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA from March to August 2003. A total of 30 upper limbs of adult cadavers perfused with red latex through arteries were provided by Research Center for Clinical Anatomy, Military Institute of Orthopaedics, Fuzhou General Hospital of Nanjing Military Area Command of Chinese PLA. Each cadaver was injected with a mixture of red gelatin to show the branches, distributions and anastomosis of the lesser vessels on the stained small arteries of the finger tips.

METHODS:

All 30 adult upper limbs were dissected and observed under the microscope based on the pivot point of styloid process of ulna ①The origins, branches, distribution and anastomosis of nutrient vessels of the inferior 1/3 segment of medial antebrachial cutaneous nerve-basilic vein, and whose blood supply relationship with ulnar periosteal vessels. ②The superficial and deep communicating branches of basilic vein.MAIN OUTCOME

MEASURES:

①The origins, branches, distribution and anastomosis of nutrient vessels of medial antebrachial cutaneous nerve, and whose blood supply relationship with vicinal bone and skin. ② The superficial and deep communicating branches of basilic vein.

RESULTS:

①The origins of nutrient vessels supplying the inferior 1/3 segment of the lateral antebrachial cutaneous nerve were 5-9 cutaneous branches of ulnar artery with an outer diameter of (0.7±0.3)mm. The ascending and descending branches of wrist superior branches sent out several cutaneous branches nourishing basilic vein, with an outer diameter of (0.6±0.3) mm. Between the position of (6.0-16.0) cm superior to ulnar malleolus, anterior interosseous artery sent out 2-3 perforating bone-skin branches, with an outer diameter of (0.7±0.2) mm; Posterior interosseous artery sent out 1-3 bone-skin perforating branches, with an outer diameter of (0.6±0.3) mm. Both of them were distributed on periosteum and skin of the corresponding area. All above-mentioned cutaneous perforators gave off cutaneous branches, fascia branches, periosteal branches and nutrient vascular branches of cutaneous nerve-superficial vein, and a vessel chain of cutaneous nerve-basilic vein and vascular networks of deep fascia, superficial fascia and periosteum formed. ②Ulnar artery had two accompanying veins, one was grossus, and the other thin. The two veins accompanied along two sides of artery, and the accompanying vein of arterial cutaneous branches infused. Superior wrist cutaneous branches of ulnar artery had two accompanying veins. One pumped into ulnar branch of ulnar vein, and the other one passed through deep fascia, then entered subcutaneous tissue, and straightly pumped into basilic vein. The injected position was (2.3±0.8) cm superior to ulnar malleolus, with an outer diameter of (2.8±0.5) mm.

CONCLUSION:

The nutrient vessels of medial antebrachial cutaneous nerve-basilic vein and the nutrient vessels of bone and skin are homologous. The rotation point of their distally based pedicled flap and compound flap can reach the plane of wrist joint, which can be applied to repair the distal tissue defects of the hand.