Gosain A K, Matloub H S, Yousif N J, Sanger J R
Department of Plastic and Reconstructive Surgery, Medical College of Wisconsin, Milwaukee 53226.
Ann Plast Surg. 1992 Dec;29(6):496-507. doi: 10.1097/00000637-199212000-00004.
We studied the vascular relationship of the lateral arm flap to triceps tendon and muscle in 16 dissected cadaver arms. We designed composite lateral arm free flaps containing fasciocutaneous components, triceps muscle, and/or triceps tendon. Vascular communication between the lateral arm fascia and triceps tendon was negligible. In contrast, a mean of 3.6 vessels passed through triceps muscle from the posterior radial collateral artery to the harvested triceps tendon; in each dissection at least 1 vessel entered the proximal 5 cm and 1 vessel entered the distal 5 cm of harvested tendon. Methylene blue injections confirmed that perfusion of the triceps tendon was through triceps muscle and not through lateral arm fascia. We used the composite lateral arm free flap in 6 patients, 3 with triceps muscle and 3 with triceps tendon. Baltimore Therapeutic Evaluation testing in those patients where triceps tendon was harvested showed no deficit in elbow extension. Complete coverage of composite defects was achieved with a single surgical procedure in all patients.
我们在16具解剖后的尸体手臂上研究了臂外侧皮瓣与肱三头肌腱和肌肉的血管关系。我们设计了包含筋膜皮肤成分、肱三头肌和/或肱三头肌腱的复合臂外侧游离皮瓣。臂外侧筋膜与肱三头肌腱之间的血管交通可以忽略不计。相比之下，平均有3.6支血管从桡侧副动脉经肱三头肌进入所采集的肱三头肌腱；在每次解剖中，至少有1支血管进入所采集肌腱近端5 cm处，1支血管进入所采集肌腱远端5 cm处。亚甲蓝注射证实肱三头肌腱的灌注是通过肱三头肌而不是通过臂外侧筋膜。我们对6例患者使用了复合臂外侧游离皮瓣，其中3例含有肱三头肌，3例含有肱三头肌腱。对那些采集了肱三头肌腱的患者进行的巴尔的摩治疗评估测试显示，其肘关节伸展功能没有缺陷。所有患者均通过单一手术实现了复合缺损的完全覆盖。
