人体皮肤微血管构筑的三维可视化*

背景：常用的血管解剖学研究方法如逐层解剖、血管染色、造影摄片可以确定血管的位置、大至供血范围等，但难以显示皮肤微血管立体构筑。 目的：建立三维的皮肤微血管构筑模型，以评估和设计穿支皮瓣。 方法：选取2具新鲜成人尸体标本，以羧甲基纤维素明胶氧化铅灌注标识血管，CT扫描获取标本灌注前后及剥离皮肤序列图像数据，利用Mimics13.1软件进行皮肤微血管三维重建和穿支皮瓣设计。 结果与结论：实验成功重建了骨骼、血管、皮肤三维数字模型，并选择性设计了旋股外侧动脉皮瓣和旋肱后动脉的主要穿支皮瓣。构建的皮肤微血管模型不仅可显示皮穿支的长度管径、立体位置、走行方向、分布范围、毗邻关系，还可追踪其来源血管，与来源血管、骨骼、皮肤等搭配显示。说明皮肤微血管构筑可揭示穿支皮瓣的范围和扩张方向，有利于穿支皮瓣的设计发掘、血供评估。

Three-dimensional visualization of human cutaneous microvasculature

BACKGROUND: Angiotomy methods such as dissection, ink injection and angiographs techniques have been used to identify vessel location. However, these techniques rarely provide a steric architecture of the cutaneous angiosome. OBJECTIVE: To establish three-dimensional (3D) architecture of the cutaneous angiosome for assessing and designing perforator flaps. METHODS: Two fresh cadavers were injected with carboxymethyl cellulose/lead oxide and subjected to CT scanning before and after the injection to obtain data of the cutaneous and subcutaneous tissue derived from one injected cadaver. Three-dimensional reconstruction and perforator flaps design were performed using Mimics13.1 software. RESULTS AND CONCLUSION: Three-dimensional digital models of the bone, blood vessels, skin were obtained. The flap with total perforator of external femoral circumflex artery and the flap with main perforator of posterior humeral circumflex artery were developed. The 3D microvascular architecture model can clearly display the spatial location, distribution range and anastomose relationship of the cutaneous perforators, the caliber, length, position of particular source artery in the exact spatial location. As a result, it visualized the general area and expandable direction of a respective flap. This technique facilitates perforator flaps design and blood supply evaluation.