腹壁下动脉穿支皮瓣血管穿支及感觉神经的应用解剖

Anatomic study of perforator neurovascular bundles of the deep inferior epigastric perforator flap

目的 为腹壁下动脉穿支 (deepinferiorepigastricperforator,DIEP)皮瓣感觉的修复提供解剖学依据。方法 对 9具 18侧常规防腐固定的成年女尸腹前外侧壁进行详细解剖学研究。结果 腹壁下动脉穿支主要位于腹直肌鞘区 ,平均每侧 17 5支 ,直径≥ 0 5mm者 7 8支 ,直径≥ 0 5mm者 9 7支 ,其中皮瓣上半部最多 ,内侧略多于外侧。DIEP皮瓣主要位于T9～T12神经节段范围内 ,5 6 2 %DIEP有感觉神经穿支伴行 ,而粗大DIEP的感觉神经伴行率高达 80 .9%。结论 切取以腹壁下动脉穿支为血供来源、以肋间神经感觉支为感觉支配的DIEP皮瓣时 ,穿支选择应以脐周外侧粗大神经血管束为首选。

Objective To investigate the anatomic characteristics of the perforator neurovascular bundles in the anterior abdominal wall for the anatomical basis of the sensate deep inferior epigastric perforator (DIEP) flap. Methods Abdominal wall dissection was performed on 9 embalmed female cadavers (18 sides). Results Most of the deep inferior epigastric perforators emerged at the anterior sheath of the rectus. There were averaged 17 5 perforators on each side, with the diameter equal to or larger than 0 5 mm in 7 8 perforators. The number of skin perforators was the greatest in the supero-medial area. 56 2 percent of vascular perforators traveled with the sensory branches while 80 9 percent of larger perforators (≥0 5 mm in diameter) run with the sensory branches. Conclusions The lateral perforator neurovascular bundle was the first choice in the design of the sensate DIEP flap.