第9、10肋间神经外侧皮支营养血管皮瓣的解剖与临床应用

Applied anatomy of neurocutaneous vascular flap (NCVF) with the lateral cutaneous branches of T_9, T_(10) and their nutrient vessels origining from its pedicle

目的 :为季肋部皮神经营养血管皮瓣提供解剖学基础。方法 :在 17例 3 4侧成人躯干标本上 ,观察了第 9、10肋间神经外侧皮支及其营养血管的来源、走行及分布规律 ;在临床上 ,应用第 9肋间神经外侧皮支皮神经营养血管皮瓣修复组织缺损 2例。结果 :第 9、10肋间神经外侧皮支从腋中线前后相应肋间穿出深筋膜 ,分为前、后支 ,呈节段性、重叠性分布于侧胸腹部皮肤。皮神经营养血管相互间形成丰富的吻合。临床应用取得了满意的疗效。结论 :以第 9、10肋间神经外侧皮支营养血管为蒂 ,可以设计皮神经营养血管皮瓣。

Objective: To provide anatomical basis for NCVF with the lateral cutaneous branches (LCBs) of T 9, T 10 and their nutrient vessels resourcing from its pedicle. Methods: The origin, branch and distribution of the LCBs of T 9, T 10 and their nutrient vessels were observed on 17 adult specimens. Results: The LCBs of T 9, T 10 penetrated through their respective intercostal tissues near mid axial line. Each LCB was divided into two opposing branches: the posterior branch, which was distributed mainly in the skin between its penetrating point and the scapular line; and the anterior branch, in the skin between its penetrating point and the semilunar line. There was a concomitant artery venous bundle at the penetrating point of each cutaneous nerve trunk (more than half the length of the nerve trunk). The diameters of these concomitant arteries ranged from 0.3mm to 1.0mm. The concomitant vein was moderately larger than the artery in diameter respectively. Usually, there were one to three segmental nutrient vessels added to the neurovascular system along the course of each cutaneous nerve. There were copious anastomoses among these vessels and between the vessels of two neighbor cutaneous nerves. The NCVF based on the lateral cutaneous branch of a single intercostal neurovascular bundle was applied in 2 patients. The operations were successful. Conclusion: Flap can be designed with the LCBs of T 9, T 10 carrying its nutrient vessels it's the pedicle.