腹壁下动脉穿支皮瓣及腹壁浅动脉皮瓣的血供解剖研究
Vascular anatomy of deep inferior epigastric artery perforator flap and superficial inferior epigastrical artery flap
目的 针对下腹部皮瓣及皮下组织的血供分区尚存在争议，对血供分区、血管及其相互间的吻合情况进行综合分析，为穿支皮瓣的应用提供解剖学基础。 方法 使用改良的一次性全身动脉造影技术，灌注10具新鲜尸体标本。经螺旋CT扫描后，应用交互式医学影像控制系统（Mimics）对腹壁下动脉及其穿支和腹壁浅动脉进行3D可视化研究,并对下腹壁区域皮肤及皮下组织等进行层次解剖与X线摄像。 结果 腹壁下动脉有3种分支形式，当其分为2支或3支时，发出相对应的内、外两排穿支。腹壁浅动脉的解剖变异度较大，但均与腹壁下动脉穿支间有丰富的吻合。 结论 腹壁血供传统分区的争议与术中选择内排或外排穿支有关。当术前确认腹壁浅动脉管径较大，且所需组织量不超过半腹部时，腹壁浅动脉皮瓣是一种很好的术式选择。
Objective To explore the vascular structures, anatomical characters of perforasome and the choke vessels in infra-abdominal region. Methods 10 fresh cadavers underwent angiography by plain film and CT scan. Three dimensional reconstructions of the deep inferior epigastric artery and its perforators, as well as the superficial inferior epigastrical artery were performed by Materialized Interactive Medical Image Controlling System. Results The course of the deep inferior epigastrical artery can be divided into three types: single branch, double branches, and triple branches. When the deep inferior egigastrical artery had more than one branch, its perforators could be classified into a lateral row perforators and medial row perforators, which was of clinical significance. Conclusions Current debates surrounding the vascular zone of the skin and its underlying fat at the infra-abdominal region are associated with the intra-operative choice of which perforator to be used: a lateral row perforator or a medial row perforator. Whenever the superficial epigastrical artery is of large diameter, and the tissue volume needed for reconstruction can be confined in a semi-abdomen, the superficial epigastrical artery flap should be regarded as a preferential choice rather than as a backup of the deep inferior egigastrical artery perforator flap.
皮瓣 / 腹壁下动脉 / 穿支 / 腹壁浅动脉 / 血管造影 / 3D可视化
Flap / Inferior epigastric artery / Perforating branch / Angiograghy / Three dimensional visualization
[1] Holmstrom H. The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report
[J]. Scand J Plast Reconstr Surg, 1979，13(3): 423-427.
[2] Hartrampf CR, Scheflan M, Black PW. Breast reconstruction with a transverse abdominal island flap
[J]. Plast Reconstr Surg, 1982，69(2): 216-225.
[3] Scheflan M, Dinner MI. The transverse abdominal island flap: part I. Indications, contraindications, results, and complications
[J]. Ann Plast Surg, 1983， 10(1): 24-35.
[4] Dinner MI, Dowden RV. The value of the anterior rectus sheath in the transverse abdominal island flap
[J]. Plast Reconstr Surg, 1983，72(5): 724-726.
[5] Allen RJ, Treece P. Deep inferior epigastric perforator flap for breast reconstruction
[J]. Ann Plast Surg, 1994， 32(1): 32-38.
[6] Blondeel PN, Boeckx WD. Refinements in free flap breast reconstruction: the free bilateral deep inferior epigastric perforator flap anastomosed to the internal mammary artery
[J]. Br J Plast Surg, 1994， 47(7): 495-501.
[7] Stern HS, Nahai F. The versatile superficial inferior epigastric artery free flap
[J]. Br J Plast Surg, 1992， 45(4): 270-274.
[8] Grotting JC. The free abdominoplasty flap for immediate breast reconstruction
[J]. Ann Plast Surg, 1991, 27(4): 351-354.
[9] Holm C, Mayr M, Hofter E, et al. The versatility of the SIEA flap: a clinical assessment of the vascular territory of the superficial epigastric inferior artery
[J]. J Plast Reconstr Aesthet Surg, 2007, 60(8): 946-951.
[10]Fukaya E, Kuwatsuru R, Iimura H, et al. Imaging of the superficial inferior epigastric vascular anatomy and preoperative planning for the SIEA flap using MDCTA
[J]. J Plast Reconstr Aesthet Surg, 2011,64(1): 63-68.
[11]Thoma A, Jansen L, Sprague S, et al. A comparison of the superficial inferior epigastric artery flap and deep inferior epigastric perforator flap in postmastectomy reconstruction: A cost-effectiveness analysis
[J]. Can J Plast Surg, 2008, 16(2): 77-84.
[12]李保锴, 王立荣, 侯贺宪, 等. 下腹壁浅动脉岛状皮瓣修复重度腹股沟区损
[J]. 中国修复重建外科杂志, 2001, 15(4): 201.
[13]王晓敏, 张凯, 马士崟, 等. 腹壁浅动脉皮瓣的应用解剖研究
[J]. 中国修复重建外科杂志, 2010, 24(11): 1357-1360.
[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]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.
[17]Wong C, Saint-Cyr M, Arbique G, et al. Three- and four-dimensional computed tomography angiographic studies of commonly used abdominal flaps in breast reconstruction
[J]. Plast Reconstr Surg, 2009, 124(1): 18-27.
[18]Blondeel PN, Arnstein M, Verstraete K, et al. Venous congestion and blood flow in free transverse rectus abdominis myocutaneous and deep inferior epigastric perforator flaps
[J]. Plast Reconstr Surg, 2000,106(6): 1295-1299.
[19]Rahmanian-Schwarz A, Rothenberger J, Hirt B, et al. A combined anatomical and clinical study for quantitative analysis of the microcirculation in the classic perfusion zones of the deep inferior epigastric artery perforator flap
[J]. Plast Reconstr Surg, 2011,127(2): 505-513.
[20]Holm C, Mayr M, Hofter E, et al. Perfusion zones of the DIEP flap revisited: a clinical study
[J]. Plast Reconstr Surg, 2006, 117(1): 37-43.
[21]Wolfram D, Schoeller T, Hussl H, et al. The superficial inferior epigastric artery (SIEA) flap: indications for breast reconstruction
[J]. Ann Plast Surg, 2006, 57(6): 593-596.
[22]陆林国, 徐秋华, 燕山, 等. 高频彩超对穿支皮瓣血管的探索研究
[J]. 上海医学影像, 2008,17(3): 200-202.
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