Dallas, Texas; and Louisville, Ky. From the Department of Plastic Surgery, University of Texas Southwestern Medical Center, and the Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville School of Medicine.
Plast Reconstr Surg. 2010 May;125(5):1469-1478. doi: 10.1097/PRS.0b013e3181d511e7.
The purpose of this study was to determine the location, size, and vascular territory of the radial artery cutaneous perforators.
Twenty-six human cadaveric forearms were dissected. All cutaneous radial artery perforators were analyzed for total number, orientation, location, and external diameter. A cluster analysis was performed to determine the overall distribution of perforators. The cutaneous territory of a distally based pedicled perforator flap was determined using methylene blue injection and three-dimensional computed tomographic angiography in five flaps.
Six hundred thirty-nine perforators (399 perforators smaller than 0.5 mm compared with 240 perforators 0.5 mm or larger) were dissected in 26 forearms. Of the 639 radial artery perforators dissected, 328 (51 percent) were radially distributed and 311 (49 percent) were ulnarly distributed. There are two main clusters of clinically relevant perforators at a relative distance of 17.6 percent and 61.7 percent along the radial styloid-to-lateral epicondyle interval. In all cases, two or more perforators were found within 2 cm proximal to the styloid. Dye injection of the most dominant distally based perforators revealed a cutaneous territory ranging from 104 cm2 to 333 cm2. The case presented is of a patient with a dorsal hand defect, which was resurfaced with a pedicled perforator flap based on a distal perforator proximal to the radial styloid.
There are two main clusters of clinically significant radial artery perforators. Increased knowledge of size, location, and cutaneous territory of the radial artery perforators can lead to expanded use of the radial artery forearmflap based on cutaneous perforators alone, without sacrificing the radial artery.
本研究旨在确定桡动脉皮穿支的位置、大小和血管分布区域。
对 26 例人体前臂标本进行解剖。对所有桡动脉皮穿支进行总数、方向、位置和外径分析。采用聚类分析确定穿支的整体分布情况。在 5 例皮瓣中，通过亚甲蓝注射和三维 CT 血管造影确定基于远端蒂穿支的皮瓣皮区。
在 26 个前臂中解剖出 639 个穿支（399 个小于 0.5mm，240 个大于或等于 0.5mm）。在 639 个桡动脉穿支中，328 个（51%）呈桡侧分布，311 个（49%）呈尺侧分布。在桡骨茎突至外侧髁的间隔上，存在两个主要的临床相关穿支簇，相对距离分别为 17.6%和 61.7%。在所有情况下，在茎突近端 2cm 内都发现了两个或更多的穿支。对最主要的远端蒂穿支进行染料注射，显示皮区范围为 104cm2 至 333cm2。本文报道了 1 例手背背侧缺损患者，采用基于桡骨茎突近端远端穿支的带蒂穿支皮瓣进行修复。
存在两个主要的临床意义上的桡动脉穿支簇。增加对桡动脉穿支大小、位置和皮区的认识，可以在不牺牲桡动脉的情况下，扩大基于皮穿支的桡动脉前臂皮瓣的应用。
