Applied Anatomy Of The Neurocutaneous Flap Pedicled With Forearm Proximal Vascular Perforator And Study Of Postoperative Application Of Buyang Huanwu Tang

Objective:①To provide anatomical basis for lateral antebrachial or medial forearm neurocutaneous flap pedicled with proximal radial artery or proximal ulnar artery perforator in repairing tissue defects around elbow joint.Through the technologe of perfusion and microanatomy,the course,distribution and the anastomoses of the proximal radial artery,proximal ulnar artery perforator nutrient vessels of medial forearm cutaneous nerve (MFCN) and lateral antebrachial cutaneous nerve(LACN) can be clearly obersved;②Using the lateral antebrachial or medial forearm neurocutaneous flap pedicled with proximal radial artery or proximal ulnar artery perforator to repaire tissue defects around elbow joint, routinely using Buyang Huanwu Tang to prevernt arteriovenous crises after operation,observing the clinic effort,and estimating the clinic significance of this operation.Methods:30 embalmed upper limbs of adult cadavers perfused with red latex were used for this anatomic study,and followings were observed;①The origin,course,distribution and the diameter of the proximal radial artery,proximal ulnar artery perforator;②The course, and distribution of the MFCN and LACN;③Anastomoses between the proximal radial artery or the proximal ulnar artery perforator and nutrient vessels of LACN or MFCN.Two mimic operation were performed on other two sides of fresh specimen.10 cases were adopted on clinical practice,4 cases caused by traffic Injury,5 by wringer injury,and the rest caused by local hypertrophic scar among the10.All the operation were elective surgery.The wound size from 3.0cm×5.0cm to 6.0cm×8.0cm.4 flaps pedicled with proximal radial artery perforator and 6 flaps pedicled with proximal ulnar artery perforator were brought into operation. Buyang Huanwu Tang were routinely used after operation in order to prevent vascular crises,and observing the clinic effort.Results:The MFCN which is bigger than average companies with basilic vein and goes in the superficial fascia of medial forearm between flexor carpi ulnaris and palmaris longus. The MFCN is distributed on medial forearm and its distally up to rasceta.The main trunk of LACN lined in the radial forearm and distributed in the 1/3 region of lateral forearm;②The nutrient vessels of MFCN and LACN are plurisegmental and polyphyletic.The proximal ulnar artery perforator is relatively constant,it starts from ulnar artery and firstly goes between flexor digitorum superficialis and flexor digitorum profundus,then goes between flexor digitorum superficialis and flexor carpi ulnaris and perforates deep fascia into subcutaneous tissue where is 8.7cm below epitrochlear.Then proximal ulnar artery perforator gives off many small vessels which anastomose with those nutrient vessels of MFCN,these vessels form a vascular plexus which goes along MFCN between flexor digitorum superficialis and flexor carpi ulnaris.The proximal ulnar artery perforator is (2.0±0.2) cm in length,and its diameter is (0.9±0.2) mm.The proximal radial artery perforator which was relatively constant reached to skin through "V"-shaped peak,where is (4.0±0.9) cm below the middle point of medial and lateral epicondyle of humerus, formed by communicating branches of cephalic vein and deep venous system.They also gave off large number of small veins,which closely aligned with perineural branches and neural stem vascular chain of lateral antebrachial cutaneous nerve. The proximal radial artery perforator is (2.5±1.0) cm in length,and its diameter is (0.8±0.2) mm.③Based on the anatomy,10 cases were preliminary applied. The skin grafting and flaps of 8 cases were all issue survived.The distal of the flaps were slight swelling.and the epiderm appear part necrosis(1.0cm×1.0cm～2.0cm×2.5cm).The colour,lustre,texture and appearance were well.Elbow-joint all could straighten up to 150°～180°.Conclusion:①The origin,course,distribution and the diameter of the proximal radial artery,proximal ulnar artery perforator nutrient vessels of MFCN and LACN were clear and definite,and provide anatomical basis for the constructing skin vascular of front cubits;②According perforator vascular characteristics of the proximal radial artery and proximal ulnar artery,we designded the lateral antebrachial or medial forearm neurocutaneous flap pedicled with proximal radial artery or proximal ulnar artery perforator to repaire tissue defects around elbow joint,and then obtained better clinical effects;③It is simple and reliable to use the lateral antebrachial or medial forearm neurocutaneous flap pedicled with proximal radial artery or proximal ulnar artery perforator,which's blood supply is stable and reliable,Buyang Huanwu Tang which were routine used after operation can prevent vascular crises,has better clinic effort.However,there maybe certain influence to patients forearm appearance,and excessive flap area may be part necrosis.