颏下动脉带蒂皮瓣应用解剖研究

Anatomical study of submental artery island flap

目的解剖颏下动脉带蒂皮瓣,观察颏下动脉及其伴行静脉的走行和可能存在的变异及与周围重要结构的毗邻关系,并了解其支配区域组织的大小以及皮瓣所能覆盖的范围。方法取15例(30侧)新鲜汉族成人头颅湿标本,动脉系统灌注混有红色染料的乳胶,静脉系统灌注混有蓝色染料的乳胶,进行大体和显微解剖,用游标卡尺测量及统计分析,主要参数包括:颏下动脉及其伴行静脉起始部直径、颏下动脉长度及主要分支、与主要体表标志的关系等,观察典型和变异标本并照相留存。经动脉灌注黑色墨水,观察颏下皮肤染色的范围,测量并统计颏下皮瓣的最大长度和宽度,观察皮瓣所能覆盖的范围。结果颏下动脉恒定地起源于面动脉,平均长度(69.1±7.47)mm。其自面动脉发出处动脉直径为(1.6±0.47)mm,沿途分支为(6.5±1.09)支,其中支配二腹肌前腹分支较多并相对粗大,平均直径(1.1±0.25)mm。距离下颌骨下缘距离(5.4±1.63)mm。所有标本均只有一支颏下静脉伴行颏下动脉,均回流至面静脉。其静脉起始部位直径为(2.3±0.58)mm,距离下颌骨下缘距离为(15.4±3.29)mm。颏下皮瓣的大小因人而异,最大为84.6 mm×53.5 mm。结论颏下动脉是颏下皮瓣的主要供血动脉,是面动脉恒定的分支。该皮瓣血液供应丰富,易取材,可以作为头颈部修复与重建材料的良好选择。

Objective To obtain the detailed anatomical data on submental artery island flap （SAIF） including the loca- tion, dimension and relationship of the submental artery with the submental vein. Methods Fifteen cases of 30 sides of fresh adult wet cadaveric heads were examined for gross and microscopic anatomy. Artery perfusion system was mixed with red dye emulsion and intravenous with blue dye emulsion. Vernier caliper was used for measurement and statistical analysis parameters, including initial diameter of the submental artery and its accompanying vein, length and main branch of submental artery and its relation with surface mark. Typical specimen and variations were observed and photo- graphic retained. After artery was perfused with black ink, submental skin dyeing range was observed, the maximum length and width of the SAIF were measured and recorded, and the ranges that the flaps cover were surveyed. Results The submental artery was a well defined and stable branch of the facial artery, and its length was （69.1± 7.47 ; mean ± SD） rnm. At its origin, the diameter of the submental artery was （1.6±0.47） mm. The distance from mandible lower edge to submental artery was （5.4 ± 1.63 ）mm. As it courses, the submental artery gave off （6.5 ± 1.09） branches. The venous drainage of the SAIF was via the submental vein into the facial vein. The vein had a diameter of （2.30 ±0.58） mm at the origin. The maximum size of the flap could be 84.6 mm × 53.5 mm. Conclusion The submental artery is a major blood-supple artery of the SAIF, which is a constant branch of the facial artery. Because of its abundant blood sup- ply and convenient surgical proceeding, SAIF is a useful flap in head and neck repair and reconstruction.