应用旋髂深动脉皮瓣乳房再造的解剖学研究

Anatomical study of rubens’Flap in breast reconstruction

目的:探讨以旋髂深动脉及其分支为供应血管的旋髂深动脉皮瓣(Rubens'皮瓣)解剖学基础,为乳房再造尤其是组织缺损大的胸壁修复提供更多组织利用空间。方法:对4例8侧新鲜尸体标本进行大体解剖,以游标卡尺测量旋髂深动脉自髂外动脉发出起点位置、起点管径、分支数量、起点至第一分支距离、最粗穿支管径、主干血管长度等,并对1例2侧新鲜标本进行手术模拟。结果:在本次进行解剖学研究的4例8侧标本中,旋髂深动脉发自股动脉走行至髂外动脉处,起点外径平均为(3.97±0.86)mm,分支数量平均为(9.16±6.22)支,起点至第一分支距离平均为(15.87±9.24)mm,平均穿支数目为(3.12±1.34)支,最粗穿支管径平均为(1.48±1.02)mm,且与腹壁下动脉之间有丰富的血管网吻合,主干血管长度平均为(132.51±48.24)mm。在进行手术模拟的1例2侧新鲜标本中,以旋髂深动脉为蒂的Rubens'皮瓣包含层次依次为皮肤、皮下组织、部分腹外斜肌、部分腹内斜肌、部分腹横肌肌袖,皮瓣体表范围长轴平均为(13.21±2.33)cm,短轴平均为(6.42±2.12)cm。对其中1例模拟成功的皮瓣用排水法测得的皮瓣体积为146.8 mL。结论:以旋髂深动脉及其分支为供应血管的Rubens'皮瓣,紧邻腹部皮瓣,利用人体髂腰部组织量较大的特点,切取皮瓣后对供区损伤较小,既有明显的瘦腰效果,又是延伸腹部皮瓣进行乳房再造及胸壁缺损修复的较好手段,有较好的临床应用前景。

Objective:The thesis is aimed to investigate the anatomical basis of Rubens’flap based on the deep circumflex iliac artery,and to apply more donor site tissue amount for big chest wall defect.Methods:Gross anatomical study was carried on 4 fresh cadavers and data were measured by mean of the vernier caliper.Besides,surgical simulation was carried on 1 cadaver(2 sides).Results:At the inguinal segment,the via artery gave off 9.16±6.22 branches;the diameter of the origin was 3.97±0.86 mm;distant from origin to the first branch was 15.87±9.24 mm;amount of osteomusculocutaneous branch was 3.12±1.34;the biggest diameter of perforator was 1.48±1.02 mm;pedicle length was 132.51±48.24 mm.In the surgical simulation,the layers of Ruben’s flap from up to down were range in skin,subcutaneous tissue,obliquus externus abdominis,oblique internal abdominis,transversus abdominis.Conclusion:Rubens’flap,with large tissue amount,based on the deep circumflex iliac artery,near to traditional abdominal flap,has a good clinical application prospect in breast reconstruction and repair of big chest wall defect,for its thin waist effect and slight donor site defect.