目的 为股前外侧穿支皮瓣的设计与切取提供血管解剖学依据。 方法 新鲜成人尸体34具行全身血管造影灌注、CT扫描、三维重建、标本解剖与统筹分析，观测旋股外侧动脉的分支、行程与分布区域；然后按照皮瓣的设计、切取步骤，结合三维重建的影像进行解剖验证。 结果 在65侧有效标本中共观察到大腿前外侧皮肤穿支408支(平均每侧6.3支)，其中来源于旋股外侧动脉系统391支，占95.8%（391/408），来源于旋股外侧动脉各分支的占比分别为：升支9.1% （37/408）、横支16.4% (67/408)、降支60.8% (248/408)、斜支9.6% (39/408)，其穿支起始部外径分别为(0.7±0.3)、(0.9±0.4)、(1.1±0.5)、(0.8±0.3)mm ；来源于股深动脉、旋股内侧动脉、股动脉、旋髂浅动脉17支，占比4.2%，穿支起始部外径为（0.7±0.3）mm。 结论 (1)旋股外侧动脉降支仍然是股前外侧皮瓣穿支的主要源血管；(2)高位皮肤穿支主要来源于旋股外侧动脉横支与升支；(3)斜支多起源于升支与横支的共干部，具备一定的外径与蒂长，可以斜支为蒂切取皮瓣；(4)旋股外侧动脉来源穿支纤细或缺如时，可以旋股内侧动脉、股动脉等源血管来源的高位皮肤穿支切取皮瓣。
Abstract
Objective To provide vascular anatomical evidence for the design and harvesting of anterolateral thigh perforator flaps. Methods Thirty-four fresh adult cadavers underwent whole-body vascular angiography, CT scanning, 3D reconstruction, and specimen dissection for comprehensive analysis. The branches, course, and distribution areas of the lateral circumflex femoral artery were observed. Anatomical validation was then performed in accordance with the design and harvesting steps of the flap surgery, using 3D reconstructed images. Results A total of 408 anterolateral thigh skin perforators were observed in 65 effective specimens (an average of 6.3 per side), of which 391 originated from the lateral circumflex femoral artery system, accounting for 95.8% (391/408). The distribution among the branches of the lateral circumflex femoral artery was as follows: ascending branch 9.1% (37/408), transverse branch 16.4% (67/408), descending branch 60.8% (248/408), and oblique branch 9.6% (39/408). The external diameters of the perforator origin were (0.7±0.3) mm, (0.9±0.4) mm, (1.1±0.5) mm, and (0.8±0.3) mm, respectively. Seventeen perforators originated from the deep femoral artery, medial circumflex femoral artery, femoral artery, or superficial circumflex iliac artery, accounting for 4.2%, with an external diameter of (0.7±0.3) mm at the origin. Conclusions (1)The descending branch of the lateral circumflex femoral artery remains the primary source vessel for anterolateral thigh perforator flaps. (2)High-level skin perforators mainly originate from the transverse and ascending branches of the lateral circumflex femoral artery. (3)Oblique branches often originate from the common trunk of the ascending and transverse branches, possess a certain external diameter and pedicle length, and can be used as the pedicle for flap harvesting. (4)In cases where the perforators originating from the lateral circumflex femoral artery are thin or absent, flaps can be harvested from high-level skin perforators originating from the medial circumflex femoral artery, femoral artery, or other source vessels.
关键词
股前外侧皮瓣 /
旋股外侧动脉 /
三维重建 /
数字解剖学 /
穿支皮瓣
Key words
Anterolateral thigh flap /
Lateral circumflex femoral artery /
3D reconstruction /
Digital anatomy /
Perforator flap
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参考文献
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基金
国家自然科学基金（81871577）； 骨科-国家临床重点专科建设经费（Z047-01）
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