1. Applied Anatomy The pronator muscle is located on the far side of forearm, deep surface of flexor pollicis longus and flexor digitorum profundus, close to the front of ulna and radius and interosseous membrane, and it is an approximately square Achilles tendon muscle, and its blood supply is the pronator muscle branch of anterior interosseous artery, radial artery and ulnar artery, and the perforating branch of posterior interosseous artery. Periosteal flaps used in clinic include radial periosteal flap of pronator pedicled with radial branch vessels of pronator or periosteal flap of pronator pedicled with anterior interosseous vessels, and musculoskeletal flap of pronator pedicled with pronator.

The trunk of anterior interosseous artery descends from the deep surface in the middle of pronator muscle to the lower 1/3 or lower edge of muscle, and divides into two terminal branches. The anterior interosseous artery * * * sends out 7 ~ 10 pronator muscle branches with an outer diameter of 0.3 ~ 0.8 mm ... Most of the arteries are located in the medial side 1/3 and the lateral side 1/3 of the muscle.

The radial artery has l ~ 4 pronator branches, which are 4.5cm away from the styloid process of radius. The radial artery sends out constant muscle branches, which are distributed in the lower half of pronator muscle.

2. Operation method: brachial plexus anesthesia, supine position, the affected limb placed next to the operating table, not driving blood, and the upper arm tied with a balloon tourniquet. Make a big S-shaped incision near the wrist transverse striation, cut the skin and subcutaneous tissue, cut the carpometacarpal ligament, find the median nerve, protect it, enter between flexor pollicis longus and flexor pollicis longus, and pull the two muscles to both sides to see the pronator located in the deep surface of flexor pollicis longus and flexor digitorum profundus. The anterior interosseous vascular nerve bundle descends in front of the interosseous membrane, forming several branches on the pronator muscle and forming blood vessels with the branches of the ulnar and radial artery. Based on the radial blood vessel, the ulnar attachment of pronator was separated to form 2. ocm× 2。 Ocm was cut. If pedicled with pronator muscle, ulnar (membranous) flap 2. ocm× 2。 The ocm can be cut off, and the pronation radial bone (membrane) flap can also be cut off according to the anterior interosseous blood vessels.

Cut the transverse carpal ligament, enter between flexor pollicis longus and flexor digitorum profundus, expose the wrist joint capsule, cut and expose the lunate bone, remove the focus, and implant the periosteal flap at the distal end of ulna and radius with pronator pedicle. During the operation, be careful not to damage the recurrent branch of median nerve and distort the pedicle of musculoskeletal flap. Z-suture the transverse carpal ligament, and fix the wrist joint in the functional position with plaster support for 6 ~ 8 weeks after operation.