CAJ | 학술논문

目的对穿支皮瓣的解剖学研究方法进行改进,以了解穿支血管对不同厚度皮瓣的供血层次和范围,并应用于胫后动脉穿支皮瓣的研究. 方法 2013年10月-2014年10月,研究新鲜成人尸体6具,超大范围切取胫后动脉穿支皮瓣,在解剖的同时进行解剖学测量.离体皮瓣分全层、剔除深筋膜及剔除皮下脂肪层3组,将皮瓣固定于丝网网框上并照相.用硫酸钡硅胶灌注液对穿支皮瓣进行离体灌注,并进行钼靶拍照.最后将影像资料在软件上进行汇总,得出结果. 结果胫后动脉穿支平均(4.17±0.94)支,位于AC连线上宽2～3cm的区域内.供血范围近端至胫骨内髁平面以远(4.51±1.84)em,远端至内踝平面,前、后分别至前、后正中线.剔除皮瓣的深筋膜对于皮瓣的血供范围没有明显影响.剔除远端皮瓣的皮下脂肪组织后动脉穿支的供血范围没有明显改变,而剔除近端皮瓣的皮下脂肪组织后动脉穿支的供血范围明显缩小. 结论经过改进的方法能比较真实、直观地反映不同厚度穿支皮瓣的血供范围,对临床上如何切取皮瓣及对皮瓣进行修薄具有指导意义;胫后动脉穿支皮瓣的深筋膜对皮瓣血运影响不大,并且可以对远端穿支的供血范围进行皮下脂肪的适当修薄.
목적 대천지피판적해부학연구방법진행개진,이료해천지혈관대불동후도피판적공혈층차화범위,병응용우경후동맥천지피판적연구. 방법 2013년10월-2014년10월,연구신선성인시체6구,초대범위절취경후동맥천지피판,재해부적동시진행해부학측량.리체피판분전층、척제심근막급척제피하지방층3조,장피판고정우사망망광상병조상.용류산패규효관주액대천지피판진행리체관주,병진행목파박조.최후장영상자료재연건상진행회총,득출결과. 결과 경후동맥천지평균(4.17±0.94)지,위우AC련선상관2～3cm적구역내.공혈범위근단지경골내과평면이원(4.51±1.84)em,원단지내과평면,전、후분별지전、후정중선.척제피판적심근막대우피판적혈공범위몰유명현영향.척제원단피판적피하지방조직후동맥천지적공혈범위몰유명현개변,이척제근단피판적피하지방조직후동맥천지적공혈범위명현축소. 결론 경과개진적방법능비교진실、직관지반영불동후도천지피판적혈공범위,대림상상여하절취피판급대피판진행수박구유지도의의;경후동맥천지피판적심근막대피판혈운영향불대,병차가이대원단천지적공혈범위진행피하지방적괄당수박.
Objective To explore a modified technique of perforator flap anatomical study,in an attempt to understand the vascular territory of the specific perforator vessel in flaps,and determined its application in posterior tibial artery perforator flaps.Methods From October,2013 to October,2014,6 corpse were used in this study.A full-thickness posterior tibial artery perforator flap was excised from the crus of a fresh adult corpse.The anatomical measurements were synchronized with the procedure.The isolated skin flaps were fixed in a frame made of silk screen and batten and subsequently photographed.In vitro skin flaps were divided into 3 groups:full-thickness,without deep fascia,and without subcutaneous adipose layer.The skin flaps were perfused with barium sulfate silicone,and photographed using mammography after coagulation of the silicone.The imaging data were processed by digital software system.Results The mean number of posterior tibial artery perforators in the lower medial leg was 4.17 ± 0.94.The projection points of perforated sites were located in the area 2-3 cm lateral to the A-C line.The proximal border was (4.51 ± 1.84)cm distal to the plane of tibial medial condyle;the distal border reached the medial malleolus plane;and the anterior and posterior borders reaching the anterior and posterior midline of the crus respectively.And according to the comparison of the 3 group processed images,vascular territory change could be obtained.And this could provid clinicians with reliable anatomical information,guiding the acquisition and trimming of perforator flaps.Conclusion The modified strategy intuitively indicated the blood vascular areas of different artery perforator flaps of varying thickness and the vascular branches as well as their courses.The approach is profoundly significant in guiding the acquisition of skin flaps and for the trimming and reconstruction of flaps.The deep fascia of posterior tibial artery perforator flaps plays a negligible role in the blood supply of flaps.Furthermore,the subcutaneous adipose tissues in the distal portion of flaps can be thinned appropriately,with limited vascular consequences.