股前外侧区穿支动脉的形态学研究及皮瓣设计

Morphologic analysis and flap design on the perforators of anterolateral thigh

目的探讨以旋股外侧动脉降支为蒂的皮瓣设计方法,以便增加术前多普勒定位的准确性。方法6具动脉灌注明胶-氧化铅混悬液的新鲜成人整尸标本,解剖观测股前外侧区穿支,通过血管造影术和拍摄X线片测量其直径、行程、分支和定位。用3D-doctor和Scion Image软件分别测量穿支供血的趋向性、三维重建和单穿支供血面积。结果股前外侧区共有外径大于0.5 mm穿支16支,平均外径0.8 mm,平均供血面积45.61 cm^2,其中20%为肌间隙穿支,80%为肌皮穿支。平均蒂长为(3.15±1.43)cm。自旋股外侧动脉降支发出的穿支在浅筋膜中的平均长度为2.63 cm。结论改良的氧化铅-明胶灌注技术可以为皮动脉和穿支皮瓣的研究提供高质量的血管造影图像。本研究发现股前外侧单穿支皮瓣的最大供血面积是30 cm×20 cm。以股前外侧区穿支设计的穿支皮瓣可以移植到下肢或身体其他部位。

Objective To investigate a new method of improving design of the skin flap pedicled with descending branch of lateral femoral circumflex artery, in order to increase the accuracy of preoperative Doppler location. Methods Six fresh cadavers underwent a whole body, intra-arterial injection of a lead oxide and gelatine preparation. Observe the perforators of anterolateral thigh by dissection, measured their diameter; course, branches and location for there were showed up by angiography and photography. A specific program, 3D-doctor, was used for the detection of the regions of interest in angisome and its 3D-reconstructive. In addition to the average area supplied by a single perforator within that territory was calculated from digital angiograms using Scion Image. Results There were 16 perforators that the diameter ≥0. 5 mm, 20% were septocutaneous, 80% were musculocutaneous. Their average external diameter was 0. 8 mm. The average pedicle length from the deep fascia was （3.15±1.43 ）mm; the perforators from descending branch of lateral circumflex femoral artery walk length average about 2.63 cm in superficial fascia. The area of each perforator supplied blood was average 45.61 cm^2. Condusion Modified lead oxid-gelatine technique provides high quality angiograms for the study of cutaneous artery and perforator falp. Based on our data, the maximum dimension of the anterolateral thigh perforator flap can be 30 cm × 20 cm in with only a single dominant perforator. The perforator flaps deviced by perforators from the anterolateral thigh are transplanted to the lower limbs and the other part of the body.