横形腹直肌肌皮瓣感觉神经的应用解剖

Applied anatomy of the transverse rectus abdominis musculocutaneous (TRAM)flap in relation to the twelfth or twelfth thoracic nerve

目的 观察T11、T12 神经在腹直肌内及穿出前鞘后分布于下腹部皮肤的规律 ,分析横形腹直肌肌皮瓣 (transverserectusabdominismusculocutaneousflap ,TRAM )形成与T11、T12 神经相关的应用解剖学基础及手术要点。方法 在 11具 2 2侧常规防腐固定的成人尸体上 ,解剖并观测腹前外侧壁局部结构。结果 TRAM的皮神经来自T11、T12 神经前支。其主干在腹横肌与腹内斜肌之间斜行走行较长距离 ,经腹直肌外缘鞘融合后入腹直肌后面 ,除分出肌支支配腹直肌外 ,有外侧穿支、内侧穿支和升穿支分布于皮肤。结论 根据以上解剖特点 ,TRAM皮瓣可以设计以T11、T12 前支为神经蒂的感觉皮瓣 ,用于乳房再造时 。

Objective To observe the distribution of the terminal branches of the eleventh and twelfth thoracic nerve(T 11 ,T 12 )for the anatomical basis and operation key points of the transverse rectus abdominis musculocutaneous(TRAM) flap with T 11 ,T 12 .Methods\ The anterior abdominal wall was investigated through anatomical dissection in 22 embalmed cadavers.Results\ Cutaneous nerve distribution in the TRAM flap came mainly from T 11 ,T 12 .They run obliquely between transverse abdominis and obliquus internus abdominis muscle.At the lateral edge of the rectus abdominis,they piece the anterior rectus sheath into the muscle.While supplying the muscle they pass on to supply the anterior rectus sheath and the overlying skin.Conclusion\ It is possible to preserve T 11 ,T 12 in the TRAM flap,which would favour rapid return of flap sensation.