改良前额旁正中皮瓣鼻再造术的解剖学研究  

Anatomic study of the modified paramedian forehead flap in nasal reconstruction

作　　者：过云 於平[2] 丁炯[2] 孙丰华 李侃 章宏伟 

机构地区：[1]南京医科大学第一附属医院整彤烧伤外科,江苏南京210029 [2]南京医科大学基础医学院人体解剖学系．江苏南京210029

出　　处：《南京医科大学学报（自然科学版）》2008年第7期864-867,共4页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:通过对滑车上动脉的解剖,进一步明确该血管的走行特点,为设计改良的额部旁正中皮瓣提供解剖理论依据。方法:采用7具成人尸体额部(12侧)滑车上动脉标本进行解剖研究,以眶上缘和前正中线为参考点分别记录滑车上动脉发出的位置,走行特点以及与其他血管的吻合情况。结果:所有滑车上动脉均由滑车上切迹,距前正中线(1.33±0.14)cm发出,与眶上缘水平成角约82°向内上方行走。以眶上缘水平和眶上缘水平上(0.93±0.23)cm为界限,其主干走行可分为三段:第一段行于皱眉肌与眼轮匝肌之间,第二段走行于额肌表面,第三段浅行于浅层皮下,并逐渐浅出至皮内。5具尸体(8侧)滑车上动脉于眶上缘水平上(1.26±0.20)cm向外上发出分支行于皮下。滑车上动脉与眶上动脉分支、颞浅动脉额支的分支相互吻合成网前额动脉吻合网。3具标本双侧滑车上动脉之间亦有广泛吻合。额肌内没有发现轴形走向的滑车上动脉肌支血管。结论:滑车上动脉主干在眶上缘水平以上均走行于额肌之上,可设计仅蒂部带少量额肌的改良额部旁正中皮瓣行鼻再造术。Objective：To ensure the course of the supratrochlear artery by studying the anatomy to provide anatomic basis for the design of the modified paramedian forehead flap. Methods：Seven cadavers （twelve supratroehlear arteries） were used in the study. The initial position, the course of the supratroehlear artery （supraorbital rim and mldline as landmark） and the communication between the supratrochlear artery and other arteries were recorded. Results：The supratrochlear artery exited the foramen supratrochlear which was（ 1.33 ± 0.14） cm away from the midline and ascended inward. It had an angulus（about 82 degree） towards the supraorbital rim level. The course of the supratrochlear artery was divided into three parts：part Ⅰ,the artery was located between the corrugator and orbicularis oeuli muscles;part Ⅱ ,close to the previous one,the artery piercing the frontalis muscle approximately at the supraorbital rim level and ascended on the surface of the frontalis muscle from the supraorbital rim level to the place （0.93 ±0.23）cm above it; and part Ⅲ,it ascended continuely within the subcutaneous plane and then intracutaneous plane. The branch of the supratrochlear artery was found at the level（1.26±0.20）cm above the supraorbital rim in five cadavers（eight supratrochlear arteries）. And it aseended outward within the subcutaneous plane. The supratrochlear artery. communicated with the branch of the supraorbital artery and the frontal branch of the superficial temporal artery. The forehead arterial anastomotie plexus was organized by those arteries. No muscular branches was found in the frontalis muscle. Bilateral supratrochlear arteries communicated with each other. Conclusion：The supratrochlear artery travels superficial to the frontalis muscle after it reaches the supraorbital rim. So we can design the paramedian forehead flap by the course of the vessel, and the flap can be elevated without muscle,except for the pedicled part.

关 键 词：鼻再造术 滑车上动脉 前额皮瓣 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]