上侧胸部穿支的应用解剖学研究

目的　对上侧胸部皮肤的血供分布规律进行解剖学研究，为上侧胸部皮瓣的设计提供解剖学依据。 方法　新鲜成人标本10具，灌注红色乳胶氧化铅混合物后行螺旋CT进行扫描，后数据输入Mimics 13软件进行三维重建；然后进行解剖，观察并记录第9肋以上腋中线周围管径大于0.5 mm的穿支的管径、穿出点、走形于筋膜的长度及与周围血管的吻合关系；将其中2具标本躯干的被覆组织剥离下来，行X线摄影。 结果　第3、第4肋间后动脉在侧胸壁的外侧支支常常缺失或管径细小。该区域的皮肤血供分布来源于旋肩胛动脉、胸外侧动脉及胸背动脉近端的穿支。10具标本共中解剖到了109支位于第5至第8肋间隙的肋间后动脉肌皮穿支；90%侧标本上有一支优势穿支的存在，外径为（0.9±0.3）mm。在25%的标本中，可以发现优势穿支与肩胛下动脉前锯肌支的分支有吻合。 结论　 ①上侧胸部可以切取以胸背动脉外侧支为蒂大型跨区皮瓣；②第5至第8肋间隙存在恒定的肋间后动脉外侧穿支，可以切取以肋间后动脉外侧穿支皮瓣来修复四肢及躯干部皮肤缺损。

Applied anatomy of the perforators of the upper lateral thoracic wall

Objective　To investigate the vasculature in the integument of the lateral thoracic wall, and provide anatomical guide for harvesting flap at this area.　Methods　10 fresh cadavers with the vascular system injected with the lead oxide-gelatin mix were subjected to spiral CT scan, with the data obtained then imported into Mimics 13 for 3-dimentional reconstruction for the vasculature of the lateral thoracic wall. And then cadavers were dissected to explore the perforators of the lateral thoracic wall, followed with the parameters measurement, such as the caliber and suprafascial length etcd, in addition, the trunk integument of two cadavers was peeled off for X-ray radiography.　Result　The lateral perforators at the 3th and 4th intercostal spaces were small in diameter, or even absent. The integument of this region was supplied by perforators emitted from the circumflex scapular artery, the lateral thoracic artery and the thoracodorsal artery. In 10 cadavers, a total of 109 musculocutaneous perforators were explored. 1 dominant perforator could be found in 18 sides, with the diameter of about (0.9±0.3)mm. In 5 cadavers, communication existed between the dominant perforator and the branch from the anterior serratus artery. Conclusions　①large extended thoracodorsal artery flap can be harvested at the upper lateral thoracic wall; ② Constant lateral perforators were given off from the 5th to 8th intercostal artery, constituting the anatomical basis for harvest perforator flap at the lateral thoracic wall for defects resurfacing of the trunk.