Weinzweig N, Starker I, Sharzer L A, Fleegler E J
Division of Plastic Surgery, University of Illinois at Chicago, USA.
Plast Reconstr Surg. 1997 Mar;99(3):785-90. doi: 10.1097/00006534-199703000-00027.
Functional outcome after transmetacarpal replantations and revascularizations is discouragingly poor and often associated with a high incidence of intrinsic-related complications. In order to explore the hypothesis that intrinsic muscle ischemia may play a significant role, we revisited the vascular anatomy of the lumbrical and interosseous muscles. Six fresh-frozen cadaver hands were injected with latex-barium sulfate, and dissections were performed focusing on the contributions of the deep and superficial palmar arches and their branches to the intrinsic muscle vasculature. We found that the lumbrical muscles are supplied from both their volar and dorsal surfaces by both the superficial and deep palmar arches in both axial and segmental fashions. The dorsal and volar interossei receive their major blood supply from the deep arch and metacarpal arteries without any distinct pattern of axial or segmental vessels. These minute vessels cannot be repaired and are not reconstituted even with arch reconstruction. Moreover, with injuries distal to the arch, dissection of the digital arteries further disrupts this blood supply. These anatomic findings may have significant implications in clinical replantation and revascularization.
经掌骨再植和血管重建后的功能预后差得令人沮丧，且常伴有高发的内在肌相关并发症。为了探究内在肌缺血可能起重要作用这一假说，我们重新审视了蚓状肌和骨间肌的血管解剖结构。对六只新鲜冷冻的尸体手注射硫酸钡乳胶，然后进行解剖，重点关注掌浅弓和掌深弓及其分支对内在肌血管系统的供血情况。我们发现，蚓状肌在掌侧和背侧均由掌浅弓和掌深弓以轴向和节段性方式供血。背侧和掌侧骨间肌的主要血供来自掌深弓和掌骨动脉，没有明显的轴向或节段性血管模式。这些微小血管无法修复，即使进行弓重建也不能重新形成。此外，在掌弓远端发生损伤时，对指动脉的解剖会进一步破坏这种血供。这些解剖学发现可能对临床再植和血管重建具有重要意义。
