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。     

侧胸带蒂胸外侧动脉穿支皮瓣的解剖观察及其在保乳术乳房重建中的临床应用

目的 探讨带蒂胸外侧动脉穿支皮瓣在乳腺癌保乳术后部分乳房重建中临床应用的解剖学基础及效果。方法 (1)取新鲜成人尸体标本8具,其中男6具、女2具,年龄28~71岁,平均39.5岁。标本经股动脉灌注加入氧化铅的红色凝胶后,在上至锁骨、下至第五肋、外至腋前线、内至胸骨旁的区域内,解剖观察两侧胸外侧动脉的位置、走行、分支以及与周围血管的吻合情况,对胸外侧穿支血管的来源进行系统分型,并测量胸外侧动脉穿支起始处外径及血管蒂长度。(2)纳入湖南省肿瘤医院2015年8月—2019年2月收治的12例Ⅰ期乳腺癌患者临床资料进行回顾性分析,患者均为女性,年龄14～52岁,平均43.2岁。其中浸润性导管癌8例,浸润性小叶癌4例;均为单侧发病,肿瘤位于乳房外上区域9例、外下区域3例。12例均行保乳术,术中于肿瘤切除后应用带蒂胸外侧动脉穿支皮瓣行部分乳房重建,术后观察皮瓣成活情况及重建后的乳房外形。结果 (1)8具16侧标本中,有15侧出现胸外侧动脉,从胸大肌和背阔肌之间穿出,其起始处外径0.7~0.9 mm,平均0.80 mm;血管蒂长6.8～10.4 cm,平均8.15 cm,与胸肩峰动脉、胸廓内动脉、胸背动脉和肋间动脉形成丰富的血管吻合。15侧胸外侧动脉按照其来源分为6型,分别来自胸肩峰动脉(8/15,Ⅰ型)、腋血管(4/15,Ⅱ型)、胸背血管(2/15,Ⅲ型)、肩胛下血管(1/15,Ⅳ型)、多源型(1/15,Ⅴ型);另有1侧胸外侧动脉缺如(Ⅵ型)。(2)本组12例患者切除肿瘤及乳腺组织质量为70～95 (80.0±5.7)g,切取的侧胸带蒂胸外侧动脉穿支皮瓣长10.5～13.5 (11.2±0.4) cm、宽4.5～7.5 (6.3±0.5)cm、厚3.0～4.5 (3.4±0.4) cm。术后2例发生皮瓣脂肪液化,1例伤口裂开,经过换药治疗均愈合。12例患者术后随访6～20个月,平均11.5个月。所有皮瓣均顺利成活,重建乳房外形可,质地柔软,侧胸皮瓣供区仅遗留线性瘢痕,肩关节功能无明显异常;无一例出现乳腺癌复发。结论 胸外侧动脉穿支来源多样,解剖位置较恒定,且供血范围大,带蒂胸外侧动脉穿支皮瓣对于乳腺癌保乳术后乳房外侧区域重建是一个有价值的选择方案。     

游离带感觉神经腹壁下动脉穿支皮瓣在乳房再造中的应用

目的 探讨游离带感觉神经腹壁下动脉穿支皮瓣移植再造乳房的方法和效果。方法 回顾性研究。纳入2015年10月—2017年12月湖南省肿瘤医院单侧早期(Ⅰ/Ⅱ期)乳腺癌患者12例,均为女性,年龄33～52 (37.4±3.5)岁。12例均行改良根治术,并应用带感觉神经腹壁下动脉穿支皮瓣行同期乳房再造术,皮瓣携带的肋间神经感觉支与受区肋间神经吻合,腹壁下血管与受区胸廓内血管或者胸背血管吻合。记录皮瓣长度、宽度、厚度及血管蒂情况,携带感觉神经长度及选择的受区血管和神经。随访再造乳房的感觉恢复情况,将乳房分为5个区,包括4个象限和中央区,对每区的压力觉和温度觉恢复情况进行记录。完成患者主观感觉的问卷调查,内容包括外形恢复、感觉恢复和满意度。结果 皮瓣长(32.3±0.4)cm、宽(12.7±1.6)cm、厚(3.8±0.4)cm,腹壁下血管蒂长度为(12.5±0.4)cm,动脉管径为(1.7±0.4)mm,伴行静脉管径为(2.2±0.7)mm,携带肋间神经感觉支长度为(2.3±0.4)cm。受区血管为胸廓内血管(7例)和胸背血管(5例)。所有受区神经为同侧第3肋间神经。所有皮瓣顺利成活,1例皮瓣供区发生脂肪液化,经换药后愈合,未见其他并发症。再造乳房外形圆润,弹性质地可,未见皮瓣发生溃疡;皮瓣供区仅遗留线性瘢痕,腹壁功能未见影响。12例患者均获随访12～38个月,平均19.6个月,未见乳腺癌复发情况。术后12个月调查患者的感觉恢复效果,12例(100%)带感觉神经腹壁下动脉穿支皮瓣再造乳房病例中,所有再造乳房至少有1区恢复了温度觉。患者对再造乳房外形及感觉恢复均满意。结论 游离带感觉神经腹壁下动脉穿支皮瓣与受区胸壁第3肋间神经吻合有助于乳腺癌术后乳房再造的感觉功能恢复。     

腓动脉双穿支皮瓣设计的解剖学分析与临床应用

目的解剖分析小腿部腓动脉穿支的穿出规律及各穿支血管之间的联系,为临床设计腓动脉双穿支皮瓣提供形态学基础。方法新鲜小腿标本8例行动脉灌注乳胶-氧化铅,对腓动脉各穿支血管解剖结构主要是血管的形态、走形、分布进行研究分析,筛选适合做双穿支皮瓣的血管蒂。临床上应用7例,均为吻合双血管蒂皮瓣,并逐渐扩大皮瓣切取面积,皮瓣大小:5cm×9cm~8cm×15cm。结果腓动脉直径≥5mm的穿支血管4~5支,其中以第2支穿支外径最粗,外径为(0.94±0.11)mm、血管蒂较长,蒂长为(6.61±1.32)cm、皮瓣血供面积较大适合作为首选穿支蒂再联合其他穿支设计双穿支皮瓣。7例双皮支腓动脉穿支皮瓣均成活,随访3~12个月,穿支皮瓣质地优良,外观及功能恢复较佳。结论设计以第2穿支联合其他穿支的腓动脉双穿支皮瓣,皮瓣轴心线位于穿支点后侧,临床上可切取血供佳、面积较大的腓动脉穿支皮瓣。     

带腋毛穿支皮瓣的解剖学基础

目的探讨腋窝穿支的解剖学特征,为临床阴阜软组织缺损的修复提供带毛皮瓣。方法选用30侧成人尸体标本15具(30侧),通过乳胶灌注、巨微解剖等方法,重点观测:①腋窝穿支血管的起源、分支与吻合;②腋窝穿支血管的外径与长度。结果腋窝底部皮肤有3种穿支:①胸背动脉第1皮支:出现率96.7%,起始外径(1.2±0.3)mm;②胸外侧动脉第1皮支:出现率90%,起始外径(1.2±0.2)mm;③腋动脉直接穿支:出现率93.3%,起始外径(1.4±0.3)mm。结论腋窝区皮肤血供丰富,解剖恒定,至少有一条皮穿支可遴选为血管蒂设计带毛穿支皮瓣,修复因肿瘤根治术后、烧伤、创伤等原因导致的带毛区皮肤缺损。     

The number of intercostal artery perforators over the distal latissimus dorsi muscle

With the increasing popularity of perforator flaps as “musculocutaneous flaps without muscle,” a new interest in the intercostal vessels as source vessels for perforator flaps has arisen. In a recent study, the branches of the three lowermost intercostal vessels to the latissimus dorsi were studied in detail. Now that these muscular branches are well understood, the present study examines how many of these branches reach the overlying skin as musculocutaneous perforators. We identified the intercostal artery perforators in the ninth, tenth, and eleventh interspaces, in 42 hemithoraces. Only branches that measured 0.5 mm or more in external diameter were included. The course of the perforators was followed from their exit from the latissimus dorsi muscle up to the entrance at the undersurface of the skin. This entrance point was punctured by a pin and thus marked on the skin. This study showed that at least three musculocutaneous perforators were present over the intercostal spaces IX–XI in every dorsal hemithorax (average 8 ± 3, range 3–16). Potentially, each of these vessels can be used as a pedicle for a separate perforator flap, leaving the more proximal parts of the latissimus dorsi intact for a second flap based on the dominant thoracodorsal vessels. Clin. Anat. 23:216–221, 2010. © 2010 Wiley‐Liss, Inc.     

基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究

目的　探讨基于活体造影数据重建股深动脉穿动脉穿支皮瓣血供三维数字化模型的可行性,为临床股深动脉穿动脉穿支皮瓣的应用提供解剖学依据。 方法　选择8例需行皮瓣移植的患者作为研究对象,采用DSA结合CT血管成像技术获取一侧大腿二维断层图像数据,应用 Mimics 软件对股深动脉穿动脉及其穿支进行三维可视化重建,利用软件自带测量工具筛选合适穿支。 结果　利用 Mimics 软件成功重建了股深动脉穿动脉及其穿支的三维可视化模型,能清晰显示股深动脉穿动脉及其穿支的分布、走行及穿支穿出深筋膜位置。8例患者中6例发现3支穿动脉,2例发现4支穿动脉。这些穿动脉共发出66支皮肤穿支（以大于0.5 mm为标准）,穿支在穿深筋膜平面内径(0.9±0.26)mm, 穿支浅出深筋膜点主要分布于坐骨结节与股骨外上髁的连线附近。 结论　基于活体造影数据可以重建清晰股深动脉穿动脉及其穿支血管的3D立体影像,可为临床股深动脉穿动脉穿支皮瓣的术前设计与皮瓣切取提供解剖学依据。     

大鼠腹壁浅动脉穿支皮瓣的解剖学

目的探讨大鼠腹壁浅动脉穿支皮瓣的解剖学特点,为该皮瓣切取提供解剖学依据。方法 SD大鼠27只,7只行大体解剖,描述该皮瓣的解剖学特点;20只经颈总动脉行明胶-氧化铅灌注,并通过图片处理技术测量相关数据。结果腹壁浅动脉由股动脉发出后在穿浅筋膜处发出第1个分支,随即分为内外侧支,分别与胸外侧动脉和胸背动脉吻合。其外径在股动脉发出处为(0.46±0.02)mm,在穿经浅筋膜处为(0.46±0.02)mm,其营养面积为(18.37±3.67)cm2,其与胸背动脉的吻合区距离腋下水平线和腹中线分别为(5.34±0.86)cm和(4.38±0.38)cm;与胸外侧动脉的吻合区距离腋下水平线和腹中线分别为(6.28±0.69)cm和(2.04±0.33)cm。结论大鼠腹壁浅动脉解剖位置和外径恒定,是游离皮瓣移植、皮瓣动脉增压、血流动力学研究等的理想模型。     

An anatomic study of the dorsal forearm perforator flaps

Purpose

The posterior forearm is an excellent donor site for the vascular pedicled cutaneous flaps; yet, there is surprisingly little detailed anatomical information based on clinical decision making. This study was undertaken to evaluate the anatomical basis of the dorsal forearm perforator flaps and to provide anatomical landmarks to facilitate flap elevation.

Methods

Thirty cadavers were available to perform this anatomical study after arterial injection. Twenty fresh cadavers were injected with a modified lead oxide–gelatin mixture, selected for 3-dimensional reconstruction using special software (MIMICS) and the arterial territory measured with Scion Image. Other ten were injected with red latex preparation, and perforators were identified through dissection.

Results

(1) The average number of posterior interosseous artery cutaneous perforators in the dorsal forearm was 5 ± 2, the average diameter was (0.5 ± 0.1) mm, and the pedicle length was (2.5 ± 0.2) cm. The average cutaneous vascular territory was (22 ± 15) cm². Cutaneous perforators could be found along the line extending from the lateral epicondyle to the radial border of the head of ulna. (2) Dorsal branch of anterior interosseous artery supplied blood to distal third of dorsal forearm; its average diameter was 0.8 mm.

Conclusion

The free transplantation of the posterior interosseous perforator artery flaps or rotary flap pedicled by dorsal branch of anterior interosseous artery for defect reconstruction is feasible.     

腹壁下动脉穿支皮瓣的3D可视化研究

目的 为腹壁下动脉穿支皮瓣的设计与安全截取提供解剖学依据。方法 8具新鲜尸体,采用选择性颜料灌注、动脉造影及CT扫描与三维重建,重点观察腹壁下动脉肌皮穿支及其跨越正中线的有效吻合血管。然后,层次解剖观测腹前外侧壁外径≥0.5 mm 的穿支, 测量其管径及其走行、分支、分布情况并拍摄X线片。利用Photoshop与Scion Image软件分析穿支供血的趋向性及其供血面积。结果 腹壁下动脉的出现率为100%,平均每侧发出(4.8±1.7)支肌皮穿支,直径(0.7±0.2) mm,单穿支供血面积为33cm2,单个穿支皮瓣大小为20cm×15cm。结论 腹壁下动脉起源、行程及其穿支较恒定。双侧肌皮穿支间有丰富的、跨越正中线的真性吻合,具备截取跨越中线的横向跨区穿支皮瓣的解剖学基础,横向皮瓣面积可达20cm×42cm。     

女性乳房的应用解剖

目的研究女性乳房动脉和神经分布特征,为女性乳腺手术和乳房整形美容手术提供解剖学依据。方法对15具成年女性尸体30个乳房标本进行解剖,观测其动脉和神经的分支分布。结果①女性乳房血供由胸外侧动脉、胸廓内动脉、胸肩峰动脉和肋间动脉穿支提供。②第2～6肋间神经的外侧皮支和前皮支均支配女性乳房,分支走向呈"立体发散"模式达乳房腺体及皮肤。乳头和乳晕的神经以第4肋间神经为主。结论女性乳房手术应注意保护其动脉和神经。     

Septocutaneous perforators of the peroneal artery relative to the fibula: anatomical basis of the use of pedicled fasciocutaneous flap

There are many studies describing the perforating branches of the peroneal artery but none of them identifies their locations relative to fibula. The aim of this study was to demonstrate the locations of the perforators relative to the fibula and to present a case, treated with an adipofascial flap, based on one of these small arteries. In this study, nine fresh male cadavers’ legs injected with colored latex were dissected for demonstration of the longitudinal axis of these perforators. A large incision was made on the lateral part of the leg from the head of the fibula to the ankle. The peroneal perforating vessels were displayed. The posterior margin of the fibula was marked with needles from proximal to distal just above every perforator. The distance between the needle and the perforator was recorded. Their diameters were measured at the level of fascial emergence. There were four to seven perforating vessels; the larger vessels were near the proximal end of the fibula with an average of 1.1 mm and a minimum of 0.8 mm. We found that these branches were not parallel to fibula, but aligned in an oblique projection from posterior to anterior and from distal to proximal because of the course of the intermuscular septum between the soleus and peroneus longus muscles. The lowermost vessel was 1.7 cm away from the posterior margin of the fibula while the uppermost vessel was 0.25 cm away from the posterior ridge of the fibula. Adipofascial or fasciocutaneous flaps, which have important advantages in covering small to medium sized defects, can be based on the perforators of the peroneal artery. But for the centralization of the flap pedicle, the locations of the perforators, which are aligned from the lateral malleolus to the fibular head in oblique direction and from the posterior to the anterior must be taken into consideration. This knowledge is crucial for the flap design and the centralization of the vessels.     

缝匠肌穿支皮瓣的应用解剖学研究

目的　明确缝匠肌肌皮动脉穿支和肌间隙穿支的分布区域特征,为缝匠肌穿支皮瓣的临床应用提供解剖学依据。 方法　逐层解剖12侧经红色乳胶灌注的成人下肢新鲜标本,观察缝匠肌动脉血供特征、穿支数目及优势血管分布。 结果　由各动脉发出进入缝匠肌及其表面皮肤的穿支血管有7~12支,其中以缝匠肌中、上段穿支分布较为集中,主要为股动脉发出。肌皮穿支有3~4支,平均管径(1.30±　0.15)mm,蒂长(1.10±0.10)cm;肌间隙穿支2~3条,管径(1.20±0.20)mm,蒂长(1.15±0.15)cm。此外,旋股外侧动脉发出一较长肌间隙穿支,管径(1.35±0.05)mm,蒂长(7.20±1.40)cm,可达缝匠肌中段。 结论 缝匠肌中、上段穿支较多而位置相对恒定,设计缝匠肌皮瓣游离移植修复组织缺损是切实可行的。     

胫后动脉穿支皮瓣设计的应用解剖

目的　为临床设计以胫后动脉肌间隙穿支皮瓣提供解剖学基础。 方法　8例成人新鲜小腿标本,解剖观察胫后动脉肌间隙穿支血管及其分支的分布规律,设计以胫后动脉穿支为血管蒂的显微削薄穿支皮瓣、联体穿支皮瓣、穿支蒂嵌合穿支皮瓣及穿支分叶皮瓣,并模拟皮瓣切取。 结果　胫后动脉平均发出4.8支(3~7支)肌间隙穿支,有3支较恒定、外径较粗的穿支分别位于内踝上(6.7±1.1) cm、(15.8±1.8) cm和(22.6±1.7) cm处;在深筋膜下穿支可发出多支皮支、骨膜支、肌支,骨膜支的穿支主要集中在小腿中段,在同一分支点两皮支起始外径均≥0.5 mm的穿支主要集中在中、上段。 结论　在小腿中、上段的胫后动脉的第1、2穿支较恒定、外径较粗、蒂较长及可发出多种组织分支,适合切取胫后动脉穿支蒂显微削薄穿支皮瓣、联体穿支皮瓣、嵌合穿支皮瓣及穿支分叶皮瓣。     

旋髂深动脉穿支皮瓣的数字解剖学研究

目的为旋髂深动脉穿支骨皮瓣的设计与安全截取提供解剖学基础。方法选6具未经固定处理的尸体,采用改良明胶/氧化铅灌注技术进行动脉灌注,层次解剖观测腰区外径≥0.5 mm的穿支,测量其管径及其走行、分支、分布情况并拍摄X线片。利用Photoshop与Scion Image软件分析穿支供血的趋向性及每个分支的供血面积等。另选1具未固定处理的男尸,采用羧甲基纤维素/氧化铅水凝胶行一次性全身动脉造影,并进行CT扫描与三维重建。结果旋髂深动脉穿支(DCIAP)的出现率为92%,平均每侧为1.6支,直径0.7mm,其穿支出现于髂前上棘后方5~10cm,髂嵴上方12~35mm之间,供血范围为31 cm2。结论旋髂深动脉起源、行程及其穿支较恒定,具备穿支骨皮瓣的解剖学基础,可截取穿支皮瓣(肌皮瓣或骨皮瓣)进行游离移植或转位,用于复合组织缺损的重建。     

肘下动脉穿支皮瓣的解剖学观察

目的为肘下动脉穿支皮瓣移位修复肘部软组织缺损提供解剖学基础。方法在30侧经动脉内灌注红色乳胶的成人上肢标本上观测肘下动脉的起源、走行、分支与分布,另在1侧新鲜标本上进行摹拟手术设计。结果肘下动脉在肱骨内、外上髁连线中点下方(3.98±0.86)cm处,自桡动脉(占50%)、桡侧返动脉(占40%)和肱动脉(占10%)起始后,斜向外下方走行,其轴线位于肘下动脉的起始处与桡骨背侧结节(Lister结节)的连线上。肘下动脉向远侧分布达15 cm,并与桡动脉的远侧穿支、桡侧返动脉的肘外侧部皮支相互吻合。肘下动脉外径0.8 mm。结论以肘下动脉为蒂设计皮瓣,局部转移可修复肘部各方的软组织缺损。     

尺动脉穿支皮瓣的应用解剖学研究

目的　为尺动脉穿支皮瓣的临床应用提供解剖学依据。 方法　观察10具动脉铸型标本。取新鲜成人尸体25具(50侧),行一次性全身动脉造影。通过直接层次解剖,应用图像分析和测量系统Scion image,对前臂内侧区穿支进行定性、定量分析;螺旋CT扫描数据以Dicom 格式输入Mimics 图像工作站,对尺动脉穿支皮瓣进行三维重建。 结果　该区共有外径≥0.5mm 的穿支(7.0±2.0)支,外径(0.6±　0.2) mm,蒂长(2.7±1.4)cm,单穿支的供血面积(26.0±7.0)cm2。尺动脉除在远端发出粗大的尺动脉腕上皮支,在肱骨内上髁以下8～10cm处也有较粗、恒定的穿支,尺动脉多个穿支相互吻合形成前臂内侧血管链。 结论　可以尺动脉近端穿支为基础设计游离皮瓣,以内侧血管链为基础设计长而窄的增压穿支皮瓣也是切实可行的。     

足内侧穿支皮瓣设计的解剖基础

目的    为足内侧穿支皮瓣的临床应用提供解剖基础。  方法　对8侧乳胶灌注的成人下肢标本足内侧区进行显微解剖,观测各穿支血管的位置、数目、外径、蒂长及吻合等情况。  结果　足内侧区皮肤的血供有：足底内侧动脉、内踝前动脉、跗内侧动脉和母趾胫侧动脉。足底内侧动脉浅支穿母展肌在舟骨粗隆附近浅出,外径（1.08±0.20）mm;深支从母展肌和趾短屈肌的间隙内向足底内侧平均发出5.3支穿支,平均外径（0.63±0.25）mm,蒂长（0.93±0.31）cm;内侧深支的内侧支由舟骨粗隆前（1.92±0.61）cm处从母展肌上缘浅出至足内侧。母趾胫侧动脉从第一跖趾关节近侧（2.03±0.56）cm处穿出至足内侧。足底内侧动脉浅支、内侧深支的内侧支与内踝前动脉、跗内侧动脉吻合形成展肌上缘动脉弓,动脉弓的远端与母趾胫侧动脉相吻合。  结论　足内侧穿支皮瓣可设计以不同的穿支为蒂进行带蒂转移,修复前足、踝部及足跟周围软组织缺损,也可设计游离皮瓣修复手指掌侧软组织缺损。     

Arterial supply of the soleus muscle: anatomical study of fifty lower limbs

Soft tissue defects of the lower limb are a formidable challenge to the plastic surgeon but a soleus muscle flap often provides the solution. Various types of soleus muscle flap have been described, based mainly on the vascular supply. The arterial blood supply of the soleus muscle was studied in 50 cadaveric lower limbs. The blood vessels and their branches to the muscle were dissected. The distance of the origin of the perforators was measured from fixed bony landmarks. Branches of the popliteal artery trunk, the posterior tibial artery, and the peroneal artery supplied the soleus muscle. The number of branches to the soleus muscle from these main arteries were analyzed. The medial part of the muscle was supplied throughout its length by perforators arising from the posterior tibial artery. This constant feature makes the medial part of the muscle reliable as a proximally or distally based flap. The average distances of the lower perforators arising from the posterior tibial artery were 6.5 cm, 11.6 cm, and 16.8 cm from the medial malleolus. The branches of the peroneal artery were mostly distributed in the upper half of the muscle. These large pedicles allow a composite transfer of the soleus muscle with the fibula. Lower perforators were demonstrated to arise from the peroneal artery in 60% of the limbs but the scarcity of perforators in this region limits the clinical usefulness of an inferiorly based lateral hemisoleus flap. The study demonstrates the distribution of arteries entering the soleus muscle and how the information may be used in the design of soleus muscle flaps. The average numbers of the perforators arising from the vessels and their distribution have been highlighted.     

大鼠腹壁浅动脉皮瓣游离移植至腋窝模型的构建技巧

目的 推介将大鼠腹壁浅动脉皮瓣游离移植至腋窝的具体操作步骤。 方法 选取体重420 ~ 450 g的清洁级SD雄性大鼠20只,麻醉成功后备皮,设计以腹壁浅血管为蒂的4 cm × 2 cm腹股沟皮瓣,游离移植至腋窝,以胸外侧血管为受区血管,重点观察：股血管及胸外侧血管的起源、走行与分支,测量其外径和长度;大鼠生存状态;术后第7 d皮瓣存活情况。 结果 股动、静脉的管径分别为（0.72± 0.08）mm及（1.29±0.17）mm,胸外侧动、静脉的管径分别为（0.59±0.18）mm及（1.04±0.12）mm,两者适合做端端吻合。术后有2只大鼠死亡,另有3只大鼠皮瓣完全坏死,皮瓣存活率达75%。由于股动脉的破坏,患肢术后会出现跛行,1周后,随着血供的代偿,大鼠的步态逐渐恢复正常。 结论 大鼠腹壁浅动脉游离皮瓣是超级显微外科的基础研究与临床前操作练习的有效模型之一。