小腿后部穿支的3D可视化研究与皮瓣设计

Three-dimensional Visualization of the Perforating branches in Posterior Part of Leg and the Flap Design

目的：运用血管造影及其数字化模型探讨小腿后部各区穿支间的关系，为穿支皮瓣的临床应用提供解剖学依据。方法：（1）8具新鲜成人整尸，采用改良的氧化铅配方行一次性全身动脉造影。其中2具行连续螺旋CT扫描，对小腿进行三维重建。（2）将小腿后部分为上、中、下3区，层次解剖并配合x线摄影，观测各区穿支的定位、直径、走行、分支及其相互之间的吻合状况。结果：小腿后部共有外径≥0．5mm穿支（13±2．3）支，平均外径（0．8±0．2）mm，平均供血面积（38±9．0）cm2。上区的胭动脉穿支位置恒定且较粗大，向下与中区的胫后动脉、腓动脉之穿支形成不减少口径的真性吻合，其单穿支供血面积高达（55±20）cm2；下区穿支较细，沿跟腱两侧呈链状分布，向上与中区的穿支吻合。结论：小腿后部为良好的穿支皮瓣供区，中区可切取穿支皮瓣游离移植，上区与下区可分别切取近端蒂与远端蒂穿支皮瓣。

Objective：To explore the relationship of perforating branches in each region of posterior part of leg by using angiography and digitizing model, in order to provide some anatomic evidence for clinical application of the perforating branch skin flaps. Methods ： The systemic arteriography by using the modified mixture of lead oxide was performed on eight fresh adult cadavers. Among them two cadavers were serially scanned by a spiral CT and their legs were reconstructed. The posterior parts of there legs were divided into proximal, middle and distal zones. The location, diameter, courser, branches and inosculation of perforating branches in all zones were observed by a layered dissection combined with X -ray examination. Results：There were （13 ± 2. 3 ） perforating branches with diameters of over O. 5 mm in the posterior parts of the legs, the average external diameter was （0.8±0.2 ） mm, the average blood - supply area was （ 38 ±9.0 ） cm2. There were larger con- stant perforating branches from popliteal artery in the upper region. It inosculated truly with the perforating branches from posterior tibial artery and fibular artery in the middle zone, the blood - supply area of single perforating branch was （55±20）em2. The perforating branches in the distal zone were tiny, present as chain - like distribution, along with achilles tendon, which went upwards and inoseulated with those in the middle zone. Conclusions： The posterior part of leg is an excellent donor site for perforating branches skin flaps. However,those cutted from the middle zone are used for free grafting and that from the proximal and distal zones respectively,for the proxinmal and dittal pediele flaps.