腹直肌肌皮瓣的动脉分布及其在乳房再造中的意义

Arterial distribution of rectus abdominis musculocutaneous flap and its significance in breast reconstruction

目的探讨腹直肌肌皮瓣与血供的关系，为肌皮瓣的再划分及乳房再造提供理论基础。方法用大体解剖、血管X线造影方法对60侧尸体腹直肌进行观测。结果腹壁上动脉（superior epigastric artery，SEA）和腹壁下动脉（inferior epigastric artery，IEA）在腹直肌内，纵行于肌后方，根据X线造影所见其终末分支多呈螺旋状，在脐上方互相吻合，穿支到达腹直肌表面皮肤。其中腹壁下动脉在脐周围发出的穿支较粗，较腹壁上动脉在肌皮瓣分布较广。在肌内的动脉分支分布可分为3种类型：Ⅰ支型（SEA26．5％，IEA34．6％）在X线造影显示肌内有1条动脉主干。Ⅱ支型（SEA 64．7％，IEA 48．1％）在肌内有2条主要分支。Ⅲ支型（SEA8．8％，IEA17．3％）在肌内显示3条主要分支。根据解剖学研究提示，SEA、IEA在腹直肌内多数分为2支或2支以上主要分支（SEA73．5％，IEA65．4％）。结论腹直肌肌皮瓣按其动脉分支特点可分为几个部分，为部分分离转移，保持肌功能提供血管解剖基础。

Objective To study arterial distribution of rectus abdominis musculocutaneous flap and to evaluate whether it can be divided into several units for reconstruction. Methods The arteries of the rectus abdominis musculocutaneous flap were studied on 60 sides of cadavers by dissection and angiography. Results The superior epigastric artery （SEA） and the inferior epigastric artery （IEA） continued in a longitudinal direction. Most of their branches took on a typical spiral configuration and communicated with each other within muscle above the level of umbilicus. Many perforating arteries penetrated through the anterior rectus sheath to get to the overlying skin, but the highest concentration of major perforators were in the paraumbilical area. The inferior epigastric artery was more significant than superior epigastric artery in supplying the skin of the museuloeutaneous flap. Based on the studies of the vascular anatomy of muscles, we could classify arterial distribution into 3 types： type Ⅰ （SEA 26.5%, IEA 34.6 %） revealed a single main intramuscular artery; type II （SEA 64.7%, IEA 48.1%） had two major intramuscular branches; type III （SEA 8.8 0% ,IEA 17.3%） revealed three intramuscular branches. Our anatomic studies showed that the superior and inferior epigastric artery bifurcated or divided into more than two main branches in the majority of cases （SEA 73. 5%, IEA 65.4%）. Conclusion The rectus abdominis musculocutaneous flap could often be divided into several regions for breast construction which is based on the distribution of each branch of the artery.