胸廓内动脉穿支皮瓣的解剖学研究

Anatomic study on internal mammary artery perforator flap

目的探讨胸廓内动脉穿支皮瓣的解剖学基础。方法解剖中国人新鲜成人尸体5具，观察、测量10侧胸廓内动脉穿支皮瓣供血穿支的数目、类型、管径、走行、出筋膜后轴向，并对其定位。结果10侧标本均观察到大于0．5mm的第1至第4胸廓内动脉穿支皮瓣。胸廓内动脉第1至第4穿支动、静脉外径（x±s）为：（1．29±0．28）mm、（1．46±0．22）mm，（1．1±0．27）mm、（1．41±0．39）mm，（0．87±0．23）mm、（1．17±0．15）mm，（0．92±0．22）mm、（1．12±0．14）mm。优势皮穿支主要出现在胸廓内动脉第1、2穿支。胸廓内动脉穿支血管的龙胆紫充盈范围内至胸前正中线外至腋前线，上至锁骨下至剑突。结论胸廓内动脉穿支皮瓣为某些头颈肿瘤术后缺损的修复提供了选择，被认为可作为胸大肌皮瓣和胸三角皮瓣的替代皮瓣。

Objective To study the anatomy of internal mammary artery perforator （IMAP） flap. Methods Five fresh cadavers were used, the morphology and blood supply of IMAP flap were examined by the method of microsurgical anatomy. During dissections, following parameters were recorded： number, type and diameter of perforators vessels, course（infra fascia and supra fascia） and location of perforators vessels. Results All 1st -4th IMAPs were found in 10 specimen. Average diameter of 1st -4th IMAP artery/vein wasasfollows（x＋s）： （1.29±0.28）mm,（1.46±0.22）mm; （1.1 ±0.27）mm,（1.41 ±0.39）mm; （0. 87 ± 0.23 ） mm, （ 1.17 ± 0.15 ） mm ; （0.92 ± 0.22） mm, （ 1.12 ± 0.14） mm. The largest perforator was mostly first or second IMAP. The angiosomal territory of IMAPs extended from the clavicle superiorly to the xiphisternum inferiorly, from the midline medially to anterior axillary fold laterally. Conclusion IMAP flap offers an option in reconstruction of head neck defects and should be considered as an alternative to the deltopectoral flap and pectoralis major flap in some patients.