腹壁下动脉穿支皮瓣的应用解剖学研究

Applied anatomy of deep inferior epigastric perforator flap

目的为腹壁下动脉穿支(DIEP)皮瓣的临床应用提供解剖学基础。方法使用新鲜成人整尸标本10具,7具行改良的明胶-氧化铅造影,3具行聚乙烯醇-氧化铋全身动脉造影。血管造影标本先行螺旋CT扫描,应用Mimics进行3D可视化。扫描后10具尸体标本行应用解剖,经外科平面完整地截取腹前外侧壁皮肤及皮下组织并配合X线拍摄,利用Photoshop及Scion image研究DIEP有关数据。5具普通防腐固定的标本用以层次解剖,全程追踪DIEP及其源动脉。结果外径≥0.5 mm的DIEP每侧约6支,内侧穿支约占62%,外侧穿支约占38%。DIEP在腹前正中线两侧存在丰富的横行真性吻合支;脐下4 cm范围内或脐旁两侧,有较恒定的外径≥0.8 mm的穿支。结论腹壁下动脉内侧穿支为优势血管;DIEP皮瓣设计时首选近脐穿支;DIEP皮瓣具备切取跨越正中线横行皮瓣的解剖学基础。

Objective To study the morphological features of the deep inferior epigastric perforator（DIEP） using angiography and 3D visualization,in order to provide anatomic evidence for clinical application of the DIEP flap.Methods The systemic arteriography using the modified mixture of lead oxide-gelatine was performed on seven fresh adult cadavers and the polyvinyl alcohol-bismuth oxide on three specimens.All of the cadavers were serially scanned by a spiral CT.After that DIEP and their source artery were reconstructed by Mimics.The relevant information of DIEP was also observed by layers dissection combined with X-ray examination.The other five fresh bodies were used and underwent red latex injection.They were dissected by layers to observe DIEP and their source artery with whole course tracing.Results An average of six perforators with a diameter of over 0.5mm was located on each side of the DIEP flap.It was about 62% of the medial perforators and 38% of the lateral ones.The vascular cross-linking across the midline of the abdominal flap was rich and true.There always were perforators with a diameter of over 0.8mm within 4cm below the umbilicus or on bilateral of the umbilicus.Conclusions The medial perforators of the deep inferior epigastric artery are dominant arteries;the perforators near the umbilicus should be first considered when the DIEP flap is taken;it is reasonable to take a transverse DIEP flap.