Tellioglu A T, Sensöz O
Department of Plastic and Reconstructive Surgery, Ankara Numune Hospital, Turkey.
Ann Plast Surg. 1998 Feb;40(2):145-8.
The dorsal branch of the digital nerve was studied in 40 fingers from 8 cadavers. Our anatomic dissections showed that the dorsal branch of all digital nerves was constantly present. It arose from the digital nerve at the base of the proximal phalanx where digital vascular bifurcation usually occurred. The dorsal branch crossed the digital vascular bundle posteriorly and lay just above the extensor mechanism deeper to the dorsal-sensitive branches of the ulnar and radial nerves in the proximal and middle part of the proximal phalanx. The dorsal branch of the digital nerve supplies not only the dorsum of the middle phalanx, but also sends a branch to the dorsum of the proximal phalanx. Both dorsal branches should be used for maximal sensation while performing an innervated cross-finger flap. Furthermore, if only one digital nerve anastomosis is performed, a painful neuroma may develop from the unrepaired digital nerve stump. Therefore both of the transected digital nerves should be repaired. The dissections of the dorsal branches may be started proximally from distal palmar crease when any difficulties are encountered for nerve isolation. Nerve stumps of the dorsal branches should be placed in a deeper tissue plane and epineural sutures may be useful to prevent painful neuroma. This technique should be used in selected patients to gain maximal sensibility regarding the described points.
对8具尸体的40根手指的指神经背支进行了研究。我们的解剖显示，所有指神经的背支均恒定存在。它在近节指骨基部从指神经发出，此处通常发生指血管分叉。背支在指血管束后方交叉，位于近节指骨近端和中部尺神经和桡神经背侧感觉支深面的伸肌装置上方。指神经背支不仅供应中节指骨的背侧，还向近节指骨的背侧发出一个分支。在进行带神经的交叉手指皮瓣手术时，应使用两根背支以获得最大感觉。此外，如果只进行一根指神经吻合，未修复的指神经残端可能会形成疼痛性神经瘤。因此，两根离断的指神经均应修复。当神经分离遇到困难时，背支的解剖可从远侧掌横纹近端开始。背支的神经残端应置于更深的组织平面，神经外膜缝合可能有助于预防疼痛性神经瘤。对于特定患者，应采用该技术以在上述方面获得最大感觉。
