胸内侧皮瓣血管的巨微解剖

THE MACRO-MICROANATOMY OF THE VESSELS OF THE MEDICAL THORACIC FLAP

在手术显微镜下,解剖了成人尸体50侧,对胸内侧区皮瓣血管源进行了研究。胸廓内动脉在上4个肋间隙发出的穿动脉中,以第Ⅱ穿动脉的出现率最高,平均管径最粗,分布面积也最大。进行胸内侧皮瓣吻合血管移植时,宜首选第Ⅱ穿动脉作为血管蒂。第Ⅰ穿动脉的分布面积和中心分布区,均大于第Ⅲ或第Ⅳ穿动脉,是第二选择。胸廓内动脉跨越了几个肋间隙,其中,第2肋间隙位置较浅,距胸骨缘较远,较其他肋间隙宽,这些有利于以第Ⅱ穿动脉,甚至连同一段胸廓内动脉,作为皮瓣血管蒂的采取。如果切除一段第2肋软骨,以胸廓内动脉连同第Ⅰ、Ⅱ穿动脉为血管蒂,可以扩大皮瓣的采取范围。根据穿动脉的起源、位置、管径、浅出点、行程、分布区范围和吻合情况等,讨论了采取吻合血管胸内侧皮瓣时应注意的问题。

It is scanty in reports about the anatomy of the medial thoracic free flap,that which one of the perforating arteries of the internal thoracic artery is the main arterial source of this flap is still in dispute.This investigation was based on dissection of 50 sides of adult cadavers under the operating microscope.Among the perforating arteries of the internal thoracic artery in the upper four intercostal spaces,the second perforating artery presents a higher incidence of occurence,it also possesses a larger caliber and distributing area.So that it would be the first choice as a pedicle artery in the transplantation of the medial thoracic free flap.The next choice is the first perforating artery,because its distributing area is larger than that of the third as well as the fourth arteries.The second intercostal space is the widest among all other spaces.The internal thoarcic artery in this space is located more superficial and stands further apart from the lateral border of the sternum than that in the other three intercostal spaces.All these advantages are in favor for taking the second perforating artery as the pedicle artery of the free flap or even to take the internal thoracic artery of the same segment together with it.If a portion of the second costal cartilage isresected,the first two perforating arteries and their related portion of internal thoracic artery can be involved in the pedicle,and the area of the skin flap will be increased to a large extent.Some of the applied anatomy of the transplantation of the medial thoracic free flap has been discussed.