胸背动脉穿支皮瓣的解剖研究和临床应用  

Anatomical study and clinical application of the thoracodorsal artery perforator flap

作　　者：杨大平[1] 唐茂林[2] SteveF.Morris Christopher R.Geddes 

机构地区：[1]哈尔滨医科大学附属第二医院,哈尔滨150086 [2]温州医学院解剖教研室,浙江温州325035 [3]Division of Plastic Surgery,Dalhousie University,Halifax,B3H 3A7,Canada

出　　处：《中国临床解剖学杂志》2006年第3期240-242,共3页Chinese Journal of Clinical Anatomy

基　　金：黑龙江省杰出青年基金资助(JC-02-07)

摘　　要：目的:研究背阔肌肌皮穿支血管在皮肤内的走行和分布面积,探索背阔肌穿支皮瓣的切取范围和预测该穿支皮瓣的成活面积。方法:(1)选用10具新鲜尸体,采用改良氧化铅-明胶灌注技术进行动脉灌注。解剖胸背动脉穿支血管(口径大于0.5mm)。分别拍摄X线片以显示胸背动脉在背阔肌内和其穿支血管皮肤内的形态和分布。测定穿支血管的数量、口径及其供应区域的面积。(2)在解剖研究基础上应用了游离胸背动脉穿支皮瓣修复肢体和躯干皮肤缺损共6例。结果:发现胸背动脉发出3～6支肌皮穿支胸背动脉血管供应皮肤。其中最大的胸背动脉穿支起自外侧支,位于腋后襞下6～8cm。其以下从外侧支发出的穿支数可多达3个,每间隔1.5～4cm发出穿支。每个穿支斜行3～5cm穿过肌肉达皮肤。穿支动脉口径约为0.3～0.6mm,均有两条伴行静脉。临床应用胸背动脉穿支皮瓣6例,皮瓣最大面积为20cm×12cm,最小为15cm×8cm。皮瓣全部成活,随访8～14个月,皮瓣外形均满意,无需二次手术修薄皮瓣。供区隐蔽,无背阔肌功能障碍。结论:本研究为预测胸背动脉穿支皮瓣的成活面积及安全可靠地切取该穿支皮瓣提供解剖依据。Objoctives： This study was performed to investigate the vascular territory of the thoracodorsal artery perforator flap by describing the vascular architecture of the thoracodorsal artery to both the integument and the latissimus dorsi, and quantifying the distribution of the thoracodorsal artery perforator. Mothods： Ten fresh human cadavers were injected using a modified lead oxide and gelatin injection technique. The thoracodorsal artery perforators greater than 0.5 mm in diameter were dissected. The latissimus dorsi muscle and the overlying skin were removed and radiographs were taken to assess the pattern of vascular distribution. Data analysis included calculations for the area of skin supplied by each perforator from the thoracodorsal artery. The thoracodorsal artery perforator flap was used to repair for the skin defect in 6 cases based on the anatomical study. Results： There were 3 to 6 perforators off the distal main thoracodorsal and/or it＇s lateral branch which constitute the vascular supply of the thoracodorsal artery perforator flap. The first perforator was located approximately 6-8 cm below the posterior axillary fold. Subsequent perforators, up to a total of three, arised at 1.5-4 cm intervals inferiorly offthe lateral branch. Each perforator displayed a 3-5 cm oblique course through the muscle to supply the overlying skin. Each perforating artery was 0.3-0.6 mm in diameter and accompanied by two venae comitans. The reliable size of the thoracodorsal artery perforator flap that can be elevated on a single perforator was 15×8 cm. The maximum flap up to 25 cm×12 cm was harvested on two adjacent perforators. Conclusiona： This study provides anatomic information for understanding survival area of the perforator flap and for harvesting the reliable size of the perforator flap.

关 键 词：背阔肌 胸背动脉 肌皮动脉穿支 皮瓣 

分 类 号：R322[医药卫生—人体解剖和组织胚胎学] R616.2[医药卫生—基础医学]