腹壁下动脉穿支皮瓣的3D可视化研究

Three-dimensional angiography of the deep inferior epigastric perforator flap

目的为腹壁下动脉穿支皮瓣的设计与安全截取提供解剖学依据。方法 8具新鲜尸体,采用选择性颜料灌注、动脉造影及CT扫描与三维重建,重点观察腹壁下动脉肌皮穿支及其跨越正中线的有效吻合血管。然后,层次解剖观测腹前外侧壁外径≥0.5 mm的穿支,测量其管径及其走行、分支、分布情况并拍摄X线片。利用Photoshop与Scion Image软件分析穿支供血的趋向性及其供血面积。结果腹壁下动脉的出现率为100%,平均每侧发出(4.8±1.7)支肌皮穿支,直径(0.7±0.2)mm,单穿支供血面积为33cm2,单个穿支皮瓣大小为20cm×15cm。结论腹壁下动脉起源、行程及其穿支较恒定。双侧肌皮穿支间有丰富的、跨越正中线的真性吻合,具备截取跨越中线的横向跨区穿支皮瓣的解剖学基础,横向皮瓣面积可达20cm×42cm。

Objective To determine the anatomical basis of an algorithm to safely elevate the deep inferior epigastric artery perforator （DIEP） flap. Methods Eight fresh bodies underwent whole body gelatine/lead oxide injection, CT scanning,3D-reconstrution and the vascular cross-linking across the midline were observed. Specimens were dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the anteriolateral abdominal region. The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion hnage. Results The inferior epigastric artery was present in 100% of specimens. An average of （4. 8 ± 1.7） perforators with a diameter of （0.7±0. 2） mm perforators were located, with a perforator zone of 33 cm2 , the flap size was 20cm × 15cm. Conclusion The DIEP reliably perfuses the anteriolateral abdominal region; the vascular cross-linking across the midline of the lower abdominal flap is rich. It offers a large quantity of transverse DIEP flap on a pedicle of large diameter. The largest flap size can reach to 20cm × 42cm.