股前内侧穿支皮瓣的应用解剖学研究&nbsp;

杨晓东; 丁茂超; 梅　劲; 张根福; 杨　锦; 刘杨武; 丁建波; 唐茂林

中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (6) : 624-628.

穿支皮瓣

股前内侧穿支皮瓣的应用解剖学研究

杨晓东¹，　丁茂超²，　梅　劲²，　张根福¹，　杨　锦¹，　刘杨武¹，　丁建波¹，　唐茂林²

作者信息 +

Applied anatomy of the anteromedial thigh perforator flap

YANG Xiao-dong¹, DING Mao-chao², MEI Jin², ZHANG Gen-fu¹, YANG Jin¹, LIU Yang-wu¹, DING Jian-bo¹,TANG Mao-lin²

Author information +

文章历史 +

摘要

目的　为股前内侧穿支皮瓣的临床应用提供解剖学基础。方法　新鲜成人尸体20具(40侧)，行一次性全身乳胶灌注5具，全身动脉造影15具。通过直接层次解剖，应用图像分析和测量系统　Scion image，对股前内侧穿支进行定性、定量分析；螺旋CT扫描数据以Dicom格式输入Mimics图像工作站对该区穿支皮瓣进行三维重建。结果　股前内侧区共有外径≥0.5mm的穿支(21.0±4.0)支，外径　(0.8±0.1)mm，蒂长(4.5±2.1)cm，穿支的平均供血面积(44±4.8)cm2。将股前内侧区分为上、中、下3区，发现三个区域均有穿支供应相应区域皮肤，中1/3区是穿支分布最集中的区域，多为肌皮穿支，主要由股动脉主干，旋股外侧动脉起始部，以及膝降动脉的穿支供血。结论　股前内侧区穿支丰富，穿支蒂的来源因解剖部位而不同，在中1/3区穿支出现率较为恒定，设计股前内侧穿支皮瓣是切实可行的。

Abstract

Objective　To produce a digitized model of the anteromedial thigh for determining the anatomical relationships of perforators in each zone of the anteromedial thigh.　Methods　Five fresh unfixed corpses underwent whole body red latex injection. Fifteen fresh cadavers injected with a modified lead oxide-gelatin mixture for three-dimensional reconstruction using a spiral computed tomography scanner and specialized software (Mimics). All of specimens were then dissected by layers. Angiography and photography were used to document the precise course, size, location, and type of individual perforators in the anteromedial thigh region. The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image.　Results　The arterial supply to the integument of the anteromedial thigh was divided into proximal, middle, and distal zones. There were (21±4.0) perforators with diameters of greater than or equal to 0.5 mm; the average external diameter was (0.8±0.1) mm. Each perforator supplied an average area of (44±4.8)cm2. A number of perforators arised from the femoral artery，lateral circumflex femoral artery，and descending genicular artery in the middle zone of the anteromedial thigh.　Conclusions　The anteromedial thigh is an excellent donor site for local and distant flaps. Perforator flaps could be based in a variety of ways from each zone, especially the middle zone.

导出引用

杨晓东, 丁茂超, 梅　劲, 张根福, 杨　锦, 刘杨武, 丁建波, 唐茂林. 股前内侧穿支皮瓣的应用解剖学研究 [J]. 中国临床解剖学杂志. 2011, 29(6): 624-628

YANG Xiao-Dong, DING Mao-Chao, MEI 　Jin, ZHANG Gen-Fu, YANG 　Jin, LIU Yang-Wu, DING Jian-Bei, TANG Mao-Lin. Applied anatomy of the anteromedial thigh perforator flap[J]. Chinese Journal of Clinical Anatomy. 2011, 29(6): 624-628

中图分类号： R323.72

参考文献

[1] 郭恩覃, 季正伦, 赵月珍. 股内侧皮动脉皮瓣的临床应用
[J]. 第二军医大学学报, 1982，(4): 278-280.

[2] Baek SM. Two new cutaneous free flaps: the medial and lateral thigh flaps
[J]. Plast Reconstr Surg, 1983，71(3): 354-365.

[3] 刘元健, 刘健华, 李吉. 股内下部皮瓣显微外科解剖学
[J]. 中国临床解剖学杂志, 1989，7(1): 9-11.

[4] 刘元健, 刘健华, 李吉. 大腿内中部皮瓣显微外科解剖学
[J]. 中国医科大学学报, 1989，18(4): 284-286.

[5] 刘元健, 刘健华, 李吉. 大腿内上部皮瓣显微外科解剖学
[J]. 解剖学杂志, 1990，13(3): 216-218.

[6]关文祥, 钱云良, 程开祥, et al. 大腿内侧游离皮瓣在晚期烧伤的应用(附6例报告)
[J]. 中华烧伤杂志, 1988，4(4): 258-259.

[7] 许亚军, 寿奎水, 张全荣, 等. 代偿性股前内侧游离皮瓣移植
[J]. 中华整形烧伤外科杂志, 1996,12(6): 407-409.

[8]唐茂林, 卢书文, 李忠华, 等. 股前内侧串连血管蒂肌皮瓣设计的解剖学基础
[J]. 中华显微外科杂志, 2000,23(2): 134-135.

[9] Rodriguez A, Alvarez A, Aguirrezabalaga J, et al. The anteromedial thigh flap as a training model of a perforator flap in rat
[J]. J Reconstr Microsurg, 2007,23(5): 251-255.

[10] Lu LJ, Gong X, Cui JL, et al. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular septocutaneous perforator: application in 11 patients
[J]. Ann Plast Surg, 2011, 67(3):275-278.

[11]杨晓东, 张根福, 刘杨武, 等. 应用股前内侧穿支皮瓣修复足部创面
[J]. 中华显微外科杂志, 2010,33(3): 238-239.

[12]林加福, 郑和平, 林涧. 股内侧肌穿支蒂股中间皮神经营养血管皮瓣的应用解剖
[J]. 中国临床解剖学杂志, 2010,28(6): 614-617.

[13]楼新法, 梅劲, Geddes CR, et al. 明胶- 氧化铅血管造影术的优化
[J]. 中国临床解剖学杂志, 2006, 24(3): 259-262.

[14]张惠爱, 姜秀艳, 石小田. 聚乙烯醇-氧化铋人体血管3D可视化
[J]. 中国临床解剖学杂志, 2010, 28(5): 589-590.

[15]梅劲, 宋铁山, 戴开宇, 等. 人体皮动脉的解剖学定位定量研究
[J]. 中国临床解剖学杂志, 2006. 24(3): 236-239.

[16]江奕恒, 徐达传, 李学雷, 等. 股前外侧区皮瓣血管3D可视化研究与皮瓣设计
[J]. 中华显微外科杂志 2007,30(6): 433-436.

[17]Tang M, Yin Z, Morris SF. A pilot study on three-dimensional visualization of perforator flaps by using angiography in cadavers
[J]. Plast Reconstr Surg, 2008,122(2): 429-437.

[18]Karsidag S, Akcal A, Sirvan SS, et al. Perineoscrotal reconstruction using a medial circumflex femoral artery perforator flap
[J]. Microsurgery, 2011,31(2): 116-121.

[19]Ao M, Nagase Y, Mae O, et al. Reconstruction of posttraumatic defects of the foot by flow-through anterolateral or anteromedial thigh flaps with preservation of posterior tibial vessels
[J]. Ann Plast Surg, 1997,38(6): 598-603.

[20]Koshima I, Soeda S, Yamasaki M, et al. The free or pedicled anteromedial thigh flap
[J]. Ann Plast Surg, 1988,21(5): 480-485.

[21]许亚军, 邱扬, 姚群, 等. 股前内侧皮瓣的临床应用
[J]. 中华显微外科杂志, 1999,22(3): 222.

[22]古寺研一, 杨鹏俊. 应用顺行性穿刺股浅动脉的经皮血管腔内血管成形术
[J]. 潍坊医学院学报, 1987,(1): 196-197.

[23]Freeman NE, Leeds FH. Operations on large arteries; application of recent advances
[J]. Calif Med, 1952,77(4): 229-233.

[24]Knox G, West JP. Dacron grafts in the treatment of arteriosclerotic occlusion of the superficial femoral artery; report of seven cases
[J]. Ann Surg, 1957,145(1): 59-67.

[25]Hupkens P, Van Loon B, Lauret GJ, et al. Anteromedial thigh flaps: an anatomical study to localize and classify anteromedial thigh perforators
[J]. Microsurgery, 2010. 30(1): 43-49.