股部皮穿支的数字化解剖学研究

Digital anatomy of the perforator flap in the thigh

目的观测股部穿支分布特点，为临床设计嵌合皮瓣、血流桥接等特殊形式的穿支皮瓣提供形态学基础。方法15具尸体行一次性全身动脉造影、螺旋CT扫描及三维重建。然后进行层次解剖并配合X线摄片，应用Scion Image对各区穿支进行定性、定量分析。结果股部共有外径≥0．5mm的穿支（41±4．0）支，平均外径（0．8±0．1）mill，平均蒂长（d．2±1．7）cm，平均供血面积（44±6．4）cm。。股前内、外侧区中部，股后区的上部穿支较多。结论①由表及里的三维重建方法，可清晰地显示皮下组织内穿支的来源与分布特点；②股部各区均具备形成常规穿支皮瓣或特殊形式穿支皮瓣的形态学基础。

Objective To provide algorithmic morphological data that enables safe elevation of the flow-through perforator flap, chimeric perforator flap in the thigh. Methods 15 fresh cadavers were injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized volume-rendering software （MIMICS）. All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculate with Photoshop and Scion Image. Results The main artery supplying the thigh is femoral artery. There are （41 ± 4.0 ） perforators whose outer diameters≥ 0.5 mm. These perforators have a superficial pedicle length of （4.2 ± 1.7 ） cm. The average outer diameter is （0.8 ±0.1 ） ram. Each perforator supplies an average area of （44 ±6.4） cm2. There are lots of truly anastomoses among perforaors to form a subcutaneous network in the thigh. Conclusions The volume rendering technique is very useful for showing the subcutaneous network and preoperative flap design. The thigh appears to have the greatest potential for harvesting new or modified perforator flaps, especially, flow-through perforator flap or chimeric perforator flap.