腹壁下动脉穿支皮瓣及腹壁浅动脉皮瓣的血供解剖研究

Vascular anatomy of deep inferior epigastric artery perforator flap and superficial inferior epigastrical artery flap

目的针对下腹部皮瓣及皮下组织的血供分区尚存在争议,对血供分区、血管及其相互间的吻合情况进行综合分析,为穿支皮瓣的应用提供解剖学基础。方法使用改良的一次性全身动脉造影技术,灌注10具新鲜尸体标本。经螺旋CT扫描后,应用交互式医学影像控制系统(Mimics)对腹壁下动脉及其穿支和腹壁浅动脉进行3D可视化研究,并对下腹壁区域皮肤及皮下组织等进行层次解剖与X线摄像。结果腹壁下动脉有3种分支形式,当其分为2支或3支时,发出相对应的内、外两排穿支。腹壁浅动脉的解剖变异度较大,但均与腹壁下动脉穿支间有丰富的吻合。结论腹壁血供传统分区的争议与术中选择内排或外排穿支有关。当术前确认腹壁浅动脉管径较大,且所需组织量不超过半腹部时,腹壁浅动脉皮瓣是一种很好的术式选择。

Objective To explore the vascular structures,anatomical characters of perforasome and the choke vessels in infra-abdominal region.Methods 10 fresh cadavers underwent angiography by plain film and CT scan.Three dimensional reconstructions of the deep inferior epigastric artery and its perforators,as well as the superficial inferior epigastrical artery were performed by Materialized Interactive Medical Image Controlling System.Results The course of the deep inferior epigastrical artery can be divided into three types： single branch,double branches,and triple branches.When the deep inferior egigastrical artery had more than one branch,its perforators could be classified into a lateral row perforators and medial row perforators,which was of clinical significance.Conclusions Current debates surrounding the vascular zone of the skin and its underlying fat at the infra-abdominal region are associated with the intra-operative choice of which perforator to be used： a lateral row perforator or a medial row perforator.Whenever the superficial epigastrical artery is of large diameter,and the tissue volume needed for reconstruction can be confined in a semi-abdomen,the superficial epigastrical artery flap should be regarded as a preferential choice rather than as a backup of the deep inferior egigastrical artery perforator flap.