股前内侧穿支皮瓣的应用解剖学研究

Applied anatomy of the anteromedial thigh perforator flap

目的为股前内侧穿支皮瓣的临床应用提供解剖学基础。方法新鲜成人尸体20具(40侧),行一次性全身乳胶灌注5具,全身动脉造影15具。通过直接层次解剖,应用图像分析和测量系统Scion image,对股前内侧穿支进行定性、定量分析;螺旋CT扫描数据以Dicom格式输入Mimics图像工作站对该区穿支皮瓣进行三维重建。结果股前内侧区共有外径≥0.5mm的穿支(21.0±4.0)支,外径(0.8±0.1)mm,蒂长(4.5±2.1)cm,穿支的平均供血面积(44±4.8)cm2。将股前内侧区分为上、中、下3区,发现三个区域均有穿支供应相应区域皮肤,中1/3区是穿支分布最集中的区域,多为肌皮穿支,主要由股动脉主干,旋股外侧动脉起始部,以及膝降动脉的穿支供血。结论股前内侧区穿支丰富,穿支蒂的来源因解剖部位而不同,在中1/3区穿支出现率较为恒定,设计股前内侧穿支皮瓣是切实可行的。

Objective To produce a digitized model of the anteromedial thigh for determining the anatomical relationships of perforators in each zone of the anteromedial thigh. Methods Five flesh unfixed corpses underwent whole body red latex injection. Fifteen fresh cadavers injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized software （Mimics）. All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the anteromedial thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. Results The arterial supply to the integument of the anteromedial thigh was divided into proximal, middle, and distal zones. There were （21±4.0） perforators with diameters of greater than or equal to 0.5 ram; the average external diameter was （0.8±0.1） mm. Each perforator supplied an average area of （44±4.8）cm2. A number of perforators arised from the femoral artery, lateral circumflex femoral artery, and descending genicular artery in the middle zone of the anteromedial thigh. Conclusions The anteromedial thigh is an excellent donor site for local and distant flaps. Perforator flaps could be based in a variety of ways from each zone, especially the middle zone.