Anatomic Study On Flap With Superficial Branch Of Radial Nerve And Its Nourishing Blood Vessels

[Objective] to carry out an anatomic study on the origination,path, contribution of the superficial branch of radial nerve and it'snourishing blood vessels;their concomitant condition;the adjacentskin blood supply in order to lay a morphological base to the clinicalapplication of flap with superficial Branch of radial nerve and itsnourishing blood vessels. [Methods] 22 cadaver upper extremities irrigated with red latexwere used in this study, 17 men and 5 women, left and right in half.Microanatomy surgery was carried on in these extremities to take anobservation of the origination, path, contribution of the superficialbranch of radial nerve and it's nourishing blood vessels;theirconcomitant condition;the adjacent skin blood supply. [Results] 1, the superficial branch of radial nerve perforates deepfascia from the lateral side of the conjunction of belly and tendon ofbrachialis muscle, down to the 8.5±0.8 (5.0-10.5) cm up to the radialstyloid. The superficial branch of radial nerve convoys the cephalicvein in the superficial fascia moving downward to the 5.0±1.8(0.0-7.5) cm up to the radial styloid. At this point, the nerve dividesinto the median and lateral terminal branches. The median branch goesalong the radial side of upper extremity and turn to the dorsal sidegradually, passing the snuffle box and crossing the extensor pollicislongus till distribute to the radial side of the dorsal hand, the ulna sideof dorsal thumb, the radial side of index and middle fingers;the lateralbranch goes along the radial side crossing the metacarpophalangealjoint convoying the extensor pollicis longus, distributing to the relatedfingers and the radial side skin.2 the superficial branch of radial nerve is nourished by themuscle and cutaneous arties form the radial artery, average 4-5branches for each side. (1) (From) the exposure of radial artery,stretching from the outer side, perforating from the radial nerve stemand deep fascia (however part of the thicker radial artery cutaneousbranch going obliquely along the deep side of flexor carpi radialistendon, coming out from the radial side of the nerve stem), goingobliquely along the superficial or deep side of the nerve, distributionin a tree branches shape on the nerve and fascia surface. (2) (From)the sniffle box part of the radial artery, the backward branch of styloidis a permanent artery, it's ascendant branch joints into the nourishingartery.[Conclusion] 1,the nourishing arteries to the superficial radialnerve are from different parts of the radial artery, after perforatingdeep fascia, goes to the outer sides of the nerve, originating T shapebranches into the nerve and jointing into to the adjacent ascendant anddescendant nourishing arteries, forming into longitudinal hingenerve-artery network;moreover there are branches going into thesuperficial and deep side of the nerve, distribution in a tree shapearound the nerve fascia, knitting with the subcutaneous arteries, fasciaarteries net. Therefore forming a longitudinal and transverse arterynetwork.2,According to above anatomic research, we use different partnourishing arteries to the radial nerve as stem and design respectivelyinto a direct and retrograde flap. The direct flap uses the thickerbranch of radial artery as the stem, the distal part can reach to thestyloid deep fascia surface, direct changing position flap or overcrossing hand construction or forearms skin defection. The retrogradeflap can use the sniffle box cutaneous artery as the stem, anatomizingdiligently the thicker part of the radial artery in the primal part and thenourishing artery and vein, cutting this nerve and vascular tissue.Transfer and connect with the nerve in acceptance area. This flap canbe applied in the construction surgery to the hand and forearm tissuedefection.