肩胛下血管蒂复合组织瓣移植的解剖学基础

The anatomic basis of the complex tissue flap pedicled with the subscapular artery

目的：为以肩胛下血管为蒂复合组织瓣移植提供解剖学基础。方法：４０侧成人上肢标本解剖观察肩胛下动脉的分支类型及分布。结果：肩胛下动脉分支有３种类型：①肩胛下动脉直接分出旋肩胛动脉和胸背动脉，占５２．５％；②肩胛下动脉发出旋肩胛、胸背、旋肱后或胸外动脉，占４０％；③旋肩胛动脉与胸背动脉分别起于腋动脉，占７．５％。旋肩胛动脉恒定发浅、深支，浅支分布于肩胛冈下部筋膜皮肤，深支分布于肩胛骨外侧缘。胸背动脉恒定发肩胛骨支、前锯肌支，分布于肩胛骨外侧缘中下部、前锯肌及第５～７肋。胸背动脉于肩胛骨下角上方１．９ｃｍ处分为内、外侧支。结论：９２．５％可以肩胛下血管为蒂形成：①肩胛（骨）皮瓣与背阔肌皮瓣；②肩胛（骨）皮瓣与侧胸皮瓣；③肩胛（骨）皮瓣与前锯肌肋骨瓣。７．５％则可以胸背动脉为蒂形成背阔肌皮瓣与前锯肌肋骨瓣。

Objective: To provide anatomy basis for the transposition of the complex tissue flap pedicled with the subscapular artery. Methods: The branch and distribution of the subscapular artery was dissected and observed on 40 sides of upper limb specimen. Results: In 52.5% specimens the subscapular artery directly sent off the circumflex scapular artery and thoracodorsal artery. In 40% specimens, the subscapular artery gave off the circumflex scapular artery, thoracodorsal artery and posterior circumflex humeral artery or lateral thoracal artery. In the other 7.2% specimens the circumflex scapular artery and thoracodorsal artery originated from the axillary artery directly. There existed constantly the superficial and profound branches for the subscapular artery. The superficial branch distributed to the middle and lower part of the lateral scapular margin, anterior serratus and the 5th to 7th ribs. The thoracodorsal artery gave off the lateral and medial branches at.1.9cm above the inferior angle of sacpula. Conclusions: Three kinds of complex tissue flap such as the scapular flap and dorsal latissimus muscle flap, the scapular flap and lateral thoracal flap, the scapular flap and anterior serratus rib flap pedicaled with the subscapular artery could bedesigned in 92.5% of specimens. In other 7.5% specimens the dorsal latissimus muscle flap and anterior serratus rib flap pedicled with the thoracodorsal artery could be harvested.