엄지손가락과 첫째손샅의 등쪽 동맥분포
Anatomy of the Blood Supply of Dorsal Side of Thumb and First Web
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손등은 이식시 공여부로 흔히 사용되어 왔으며, 그중에서 등쪽손허리동맥피판(dorsal metacarpal arterial flaps)은 손가락 피부와 물렁조직의 결손부위를 덮는데 자주 사용되지만, 손등동맥의 해부학적 변이는 다양하므로 동맥피판을 다루는데 공여부 확보에 있어 어려움을 줄 수 있다. 이 연구의 목적은 엄지손가락, 집게손가락,첫째손샅(first web space)의 등쪽 동맥분포를 밝히고, 동맥피판술에 도움이 되는 해부학적 자료를 만들기 위함이다. 재료는 한국성인 시신 손 26쪽(오른손 13쪽, 왼손 13쪽, 평균나이 67.7세)을 사용하였고, 해부 전 아래팔 중간부위의 노동맥에 붉은 Latex (Latex 671, Dupont Industry, France)를 주입한 후, 해부하였다. 첫째등쪽손허리동맥 가지의 형태는 등쪽자쪽엄지가지와 등쪽노쪽집게가지가 일어나는 형태에 따라 세 가지유형으로 분류하였다. 등쪽자쪽엄지가지와 등쪽노쪽집게가지가 첫째등쪽손허리동맥에서 일어나는 경우(10예,38.5%), 첫째등쪽손허리동맥을 형성하지 않고 노동맥에서 등쪽자쪽엄지가지와 등쪽노쪽집게가지가 각각 따로분지되는 경우(5예, 19.2%), 그리고 등쪽노쪽집게가지는 노동맥에서 일어나고, 등쪽자쪽엄지가지는 엄지으뜸동맥에서 일어나는 경우(11예, 42.3%)가 있었다. 첫째등쪽손허리동맥 가지의 첫째등쪽뼈사이근에 대한 위치관계는 등쪽자쪽엄지가지가 근육에 대해 달리는 위치에 따라 두 가지 유형이 있었다. 등쪽자쪽엄지가지가 첫째등쪽뼈사이근의 표면을 달리는 경우는 17예(65.4%)가 있었고, 첫째등쪽뼈사이근에 덮여 달리는 경우는 9예(34.6%)로 관찰되었다. 등쪽노쪽집게가지는 모든 예에서 첫째등쪽뼈사이근의 표면으로 달렸다. 이상의 결과들은 엄지손가락과 첫째손샅의 등쪽 동맥분포에 대한 국소해부학적 자료를 제공함으로써, 손 외상 치료와 동맥피판술시 도움이 될 것으로 기대된다.
Abstract
Distal thumb injuries are a common and difficult problem for hand surgeons. Coverage of soft tissue on the fingers may be difficult due to the size of the defect or the limitation of local flap mobilization. However,the variable anatomy of the dorsal hand vascular system sometimes prevents successful flap harvest. The purpose of this study was to clarify the vascular anatomy of the dorsal side of the thumb and the first web for the flaps. Twenty six hands (13 right and 13 left hands) from Korean embalmed cadavers were dissected. A catheter was inserted into the radial artery in the forearm, and the red colored latex (Latex 671, Dupont Industry, France) was injected until the dorsum of the hand was colored. The arrangement of the first dorsal metacarpal artery (FDMA) and its branches were vary and classified into three categories according to their branching patterns; Both dorso-ulnar thumb branch (DUTB) and dorso-radial index branch (DRIB) arose from the FDMA (10 cases, 38.5%). Each DUTB and DRIB arose separately from the radial artery (5 cases, 19.2%). The DUTB and the DRIB originated from the princeps pollicis artery and the radial artery, respectively (11 cases, 42.3%). The typical course of the FDMA and its branches ran overlying the first dorsal interosseous muscle in 17 cases of the 26 specimens (65.4%). However, in nine cases (34.6%) the DRIB ran on the first dorsal interosseous muscle and the DUTB had a deep course within the substance of the first dorsal interosseous muscle. The FDMA flap represents a good option to cover defects for the thumb. These anatomical findings in the present study could provide useful knowledge of flaps for dorsal aspect of the thumb and the first web.
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