腹前外侧壁跨区穿支皮瓣设计的应用解剖学研究

The inter-zone perforator flap of the anterolateral abdominal wall： an anatomical study

目的研究腹前外侧壁穿支的走行、起始外径及各穿支问吻合支的出现位置。探讨腹前外侧壁跨区穿支皮瓣的切取范围和组合方式。方法对5具新鲜完整的成人尸体标本动脉造影后行CT扫描与三维重建，CT扫描后用交互式医学影像控制系统（Mimics）进行3D可视化研究，获取腹前外侧壁血管信息，观测穿支的数量以及彼此间的吻合情况、供血面积等。另对10具防腐的成人尸体标本行解剖学研究，观测腹前外侧壁区外径≥0．5mm的穿支，测量其管径及走行、分支、吻合支等情况。结果腹前外侧壁穿支间存在大量的吻合支，跨区穿支皮瓣组合后的营养面积：腹壁下动脉穿支＋旋髂浅动脉穿支皮瓣（71．5±9．5）cm2，腹壁浅动脉穿支＋旋髂浅动脉穿支皮瓣（140．6±10．4）cm2，腹壁下动脉穿支＋腹壁浅动脉穿支皮瓣（122．2±15．2）cm2。结论腹前外侧壁穿支数目、位置及走行较为恒定，穿支间存在大量吻合支，适合跨区穿支皮瓣的切取，且皮瓣的组合方式多样，为超大皮瓣的切取应用提供了一种新的术式选择。

Objective To study the course and initial diameter of anterolateral abdominal perforators and the location of choke-vessels among these perforators, and to discuss the dissecting margins and combination options of inter-zone anterolateral abdominal perforator flaps. Methods Five fresh cadavers were perfused with gelatin-lead oxide and then scanned with CT. The scans were subject to the Materialized Interactive Medical Image Controlling System （Mimics） for 3D visualization and reconstruction. Information of the anterolateral abdominal perforators, i.e. the number, anastomosis and perfusion areas of the perforators were obtained. Another 10 embalmed adult cadaver specimens were dissected to observe the anterolateral abdominal perforators with diameter greater than 0.5 mm and measure their diameter, main course and anastomosis branches. Results There were a lot of anastomosing branches between the anterolateral abdominal perforators. The perfnsion areas of the combined inter-zone perforator flaps were： （71.5 ± 9.5） cm2 for lower epigastric perforator ＋ superficial iliac circumflex perforator flap, （ 140.6 ± 10.4） cm2 for superficial epigastric perforator ＋ superficial iliac circumflex perforator flap, and （122.2 ± 15.2） cm2 for lower epigastric perforator ＋ superficial epigastric perforator flap. Conclusion The number, position and course of the anterolateral abdominal perforators are constant. There are a large number of perforator anastomosis branches which make it suitable to harvest inter-zone perforator flaps with various combination. This provides a new surgical option for harvesting over-ysized flaps.