带下部前锯肌的侧胸皮瓣解剖研究和临床应用

Anatomy and clinical application of lateral thoracic flap with lower serratus anterior muscle

目的研究下部前锯肌血供、神经及其侧胸皮瓣的解剖学特点,为临床应用提供依据。方法解剖观测8具(16侧)尸体标本的前锯肌形态、胸背动脉、胸长神经、前锯肌支的走行、分支和分布以及携带下部前锯肌的侧胸皮瓣血供特点。结果前锯肌下部的血供主要来自胸背动脉的前锯肌支,直径为(1.7±0.4)mm,以前锯肌支为蒂的肌皮瓣血管蒂长为(4.2±1.1)cm。携带下部前锯肌的侧胸皮瓣血供主要来自前锯肌皮支和肋间动脉穿支。临床应用携带下部前锯肌侧胸皮瓣6例,全部采用游离皮瓣吻合血管术式,6例均成活。侧胸皮瓣切取面积最小4.5 cm×8 cm,最大10.5cm×15 cm。随访6～10个月,皮瓣外形均满意,无需二次手术修薄皮瓣。供区隐蔽,无前锯肌功能障碍。结论以胸背动脉前锯肌支为蒂的带下部前锯肌侧胸皮瓣的血管蒂长、解剖位置恒定、血运丰富,在修复肢体皮肤软组织缺损应用方面具有很好的前景。

Objective To study the blood supply,subsidiary of nerves and anatomy of the lower serratus anterior muscle,and to provide the basis for clinical application.Methods Dissected the lower serratus anterior muscle of eight corpses（double sides） to observe its morphology,thoracodorsal artery,long thoracic nerve,path,branch,distribution of anterial serratus branch and blood supply of the lateral thoracic flap.Results The lower serratus anterior muscle was nutrilized by serratus anterior branches from thoracodorsal artery with diameters（1.7±0.4） mm.The pedicle length of lateral thoracic flap with the lower serratus anterior muscle was（4.2 ± 1.1） cm.The lateral thoracic flap with lower serratus anterior muscle was nutrilized by serratus anterior cutaneous muscle branches and vessel through intercostal arteries.Six cases of the free lateral thoracic flap with lower serratus anterior muscle were applied clinically via vascular anastomosis and all succeed.In this study,the minimum acreage of the lateral thoracic flap was 4.5 cm×8 cm and the maximum value was 10.5 cm×15 cm.Through the follow-up（6～10 months）,this study showed that appearance of this kind of flap was acceptable and secondary surgical repair was unnecessary.Furthermore,Donor site was not obvious and no serratus anterior muscle dysfunction.Conclusion Lower serratus anterior muscle of lateral thoracic flap exists a length vascular pedicle,a constant anatomical location and rich blood supply.The flap has its advantages on reconstruction of soft tissue defects.