胸廓内血管为蒂的肋骨复合组织瓣解剖学研究

Anatomical study on rib composite flap pedicled with the internal thoracic artery and veins

目的研究胸廓内血管及其前穿支对前胸壁组织供血的解剖学要点。方法新鲜成人尸体胸部2具4侧,自胸廓内动静脉起始处分别灌注红、蓝乳胶颜料。观察胸廓内血管诸穿支供应胸部皮肤的范围;10%福尔马林固定的成人尸体胸部15具30侧,采用巨微解剖学方法,观察胸廓内血管及皮肤穿支在肌肉、皮下的走行,并且测量诸前穿支穿出胸壁的具体位置、长度、外径、分支数目、吻合情况。结果胸廓内动脉穿支动脉多起自胸廓内动脉的内侧壁,前穿支的出现率以2、3穿支最常见,出现率为100%,且口径较为粗大,各穿支之间有丰富的血管吻合现象,穿支动脉的伴行静脉多为一支或缺失;前胸壁的肋骨、肋软骨、及肋间肌等结构,主要由胸廓内动脉及其分支和肋间后动脉供血。结论胸廓内血管为蒂的肋骨复合组织瓣可用于面颈部软组织伴下颌骨缺损的修复。

Objective To investigate the anatomical characteristics of the anterior chest wall blood-supply of internal thoracic artery and veins and their perforating branches. Methods The distribution and anastomosis of the internal thoracic artery and veins were observed on 4 anterior chest walls of 2 fresh adult cadavers which were infused by red and blue colorant. The origin, course, branch, external diameter, distribution and anastomosis of the internal thoracic artery and veins were observed on 30 anterior chest walls of 15 adult cadavers. The precise localization of the internal thoracic artery and its perforating branches were meastwed. Results The majority, of perforating branches originated from the medial wall of the internal thoracic artery. The second and third perforating branches were frequently seen; their incidence rates were 100%, and the antilinear was bigger. There were many anastomoses of perforating branches. There was only 1 or no perforating branch vein. The internal thoracic artery is the predominant blood-supply vessel of the anterior chest wall. Conclusion Rib composite flap pedieled with internal thoracic artery and veins is an ideal material for the reconstruction of mandibular composite tissue defect.