腓浅动脉穿支皮瓣的应用解剖学研究
杨晓东, 王建红, 吴东方, 梅 劲, 刘杨武, 杨 锦, 张根福, 唐茂林
中国临床解剖学杂志 ›› 2011, Vol. 29 ›› Issue (6) : 629-631.
腓浅动脉穿支皮瓣的应用解剖学研究
Applied anatomy of the superficial peroneal artery perforator flap
目的 为腓浅动脉穿支皮瓣的临床应用提供解剖学依据。 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,对小腿前外侧区穿支进行定性、定量分析;螺旋CT扫描数据以DICOM格式输入Mimics图像工作站,对腓浅动脉穿支皮瓣进行三维重建。 结果 该区共有外径≥0.5mm的穿支(7.0±3.0)支,外径(0.7±0.2) mm,蒂长(3.3±1.7)cm,穿支的供血面积(33.0±8.0)cm2。腓浅动脉起始外径(1.2±0.3) mm,干长(5.6±1.8) cm,与中、下1/3处腓浅下外侧动脉及腓动脉终末穿支吻合构成一条几乎不减少口径的血管链。 结论 腓浅动脉与腓浅下外侧动脉及腓动脉终末穿支相吻合构成的血管链供养小腿前外侧区皮肤,由此设计腓浅动脉穿支皮瓣是切实可行的。
Objective To provide morphological data that enables safe elevation of the superficial peroneal artery perforator flap. 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 anterolateral leg region. The surface areas of cutaneous territories and perforator zones were measured and calculated with Photoshop and Scion Image. Results The skin and muscles on the anterolateral leg are nourished by anterior tibial artery perforators and the descending branch of peroneal artery perforator. There were (7±3.0) perforators with diameters of greater than or equal to 0.5 mm. The average external diameter was (0.7±0.2) mm. Each perforator supplied an average area of (33.0±8.0) cm2. The diameter of the superficial peroneal artery was (1.2±0.3) mm at its origin from the anterior tibial artery below 5cm the head of the fibula, and the length was (5.6±1.8) cm. This artery was truly anastomoses with others perforaors to form the chain of superficial peroneal nerve accessory artery. Conclusions The anterolateral leg is an excellent donor site for local and distant flaps. Perforator flaps could be based on the chain of superficial peroneal nerve accessory artery. The volume rendering technique is very useful for preoperative flap design.
腓浅动脉 / 穿支皮瓣 / 应用解剖 / 数字解剖 / 显微外科
Superficial peroneal artery / Perforator flap / Clinical anatomy / Digital anatomy / Microsurgery
[1]周长满, 钟世镇, 刘牧之. 小腿前外侧皮瓣的解剖学 一个新的皮瓣供区
[J]. 中国临床解剖学杂志, 1983, 1(2): 97-98.
[2] 徐明, 党瑞山, 朱吉林,等. 腓浅神经的血供
[J]. 解剖学杂志, 1987, 10(4): 269-273.
[3] 黄群武, 廖进民, 谢华,等. 带腓浅神经及其营养血管筋膜皮瓣的应用解剖
[J]. 中国临床解剖学杂志, 1999, 17(1): 13-14.
[4] 赵景华, 田士松, 李宝忠,等. 带腓浅神经小腿前外侧筋膜皮瓣修复踝足部软组织缺损
[J]. 中华显微外科杂志, 2006, 29(6): 445.
[5] 崔宜栋, 蔡锦方, 刘立峰,等. 改良腓浅神经营养皮瓣修复前足皮肤软组织缺损
[J]. 中国修复重建外科杂志, 2010, 24(5): 562-565.
[6] Panagiotopoulos K, Soucacos PN, Korres DS, et al. Anatomical study and colour Doppler assessment of the skin perforators of the anterior tibial artery and possible clinical applications
[J]. J Plast Reconstr Aesthet Surg, 2009, 62(11): 1524-9.
[7] Kilinc H, Bilen BT, Arslan A. A novel flap to repair medial and lateral malleolar defects: anterior tibial artery perforator-based adipofascial flap
[J]. Ann Plast Surg, 2006, 57(4): 396-401.
[8] Rad AN, Christy MR, Rodriguez ED, et al. The anterior tibialis artery perforator (ATAP) flap for traumatic knee and patella defects: clinical cases and anatomic study
[J]. Ann Plast Surg, 2010, 64(2): 210-6.
[9] Kim NG, Lee KS, Choi TH, et al. Aesthetic reconstruction of lower leg defects using a new anterolateral lower leg perforator flap
[J]. J Plast Reconstr Aesthet Surg, 2008, 61(8): 934-8.
[10]Recalde Rocha JF, Gilbert A, Masquelet A, et al. The anterior tibial artery flap: anatomic study and clinical application
[J]. Plast Reconstr Surg, 1987, 79(3): 396-406.
[11]Kim JS, Son DG, Choi TH, et al. An anatomic study of the superficial peroneal nerve accessory artery and its perforators, and clinical application of superficial peroneal nerve accessory artery perforator flaps
[J]. Ann Plast Surg, 2008, 60(6): 710-6.
[12]袁辉宗, 史增元, 尹维刚,等. 胫前动脉前肌间隔穿支为蒂的岛状皮瓣的应用解剖
[J]. 中国临床解剖学杂志, 2011, 29(3): 249-255.
[13]Saitoh S, Hata Y, Murakami N, et al. The 'superficial' peroneal artery: a variation in cutaneous branching from the peroneal artery, nourishing the distal third of the leg
[J]. Br J Plast Surg, 2001, 54(5): 428-33.
[14]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.
[15]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.
[16]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.
[17]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.
[18]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.
[19]李会全, 刘环, 徐伟红,等. 腓浅动脉皮支蒂皮瓣的临床解剖
[J]. 潍坊医学院学报, 2004, 26(4): 267-268.
浙江省科技厅资助项目(2010C33012)
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