面部真皮下血管网皮瓣血供的解剖学基础

目的 :为面部真皮下血管网皮瓣的血供提供形态学基础。方法 :① 2个新鲜成人尸体头颈部标本 ,分别灌注红色乳胶及明胶墨汁 ,后者制成透明标本 ;②在 10侧头面部铸型标本上 ,观测面部血管分布 ;③ 2例头面部血管铸型标本 ,扫描电镜观测血管的形态特点。结果 :面部皮肤血供主要来源于面动脉、颞浅动脉及眶下动脉的分支 ,亦有上颌动脉及眼动脉的终末支分支营养 ,并因区域的不同而具有一定的方向性。它们发出的分支入浅层构成皮下动脉网 ,再由皮下动脉网发出小动脉达真皮层形成真皮下动脉网 ,并相互吻合交通 ,形似“筛网”状。结论 :面部真皮下血管网皮瓣早期主要依赖于蒂部稠密的真皮下血管网供血。临床应用时应考虑其方向性。     

侧颌颈部真皮下血管网皮瓣的解剖学基础

目的：为侧颌颈部真皮下血管网皮瓣提供形态学基础。方法：①2例新鲜成人尸体头颈部标本,分别灌注红色乳胶及明胶墨汁,切取皮瓣,后者制成透明标本;②在10侧头面部铸型标本上,观测侧颌颈部皮肤和皮瓣蒂部的动脉血管分布及静脉回流。结果：侧颌颈部皮肤血供主要来源于面动脉、颞浅动脉、枕动脉的分支,亦有甲状腺上动脉的终末支分支营养,并具有一定的方向性。其蒂部血供来源于颞浅动脉小穿支形成的真皮下血管网。颞浅动脉和面动脉的小穿支在侧颌颈区相互吻合。结论：侧颌颈部真皮下血管网皮瓣可以依赖于耳前蒂部小穿支真皮下血管网供血成活,但临床应用时应考虑其方向性。     

眶上动脉蒂反流轴型耳颞皮瓣的应用解剖

目的：明确额部各供血血管系统之间的吻合情况,为临床各型额部皮瓣特别是跨血管系统反流轴型皮瓣的应用提供解剖学基础。方法：成人尸体头面部肉眼解剖,观察眶上动脉、滑车上动脉和颞浅动脉额支的口径、走行和吻合状况等;成人头部标本制作血管铸型。结果：眶上动脉、滑车上动脉和颞浅动脉额支走行基本恒定,且三者存在众多吻合,吻合支集中区域上距眶上缘(4．9±0．4)cm,下为眶上缘水平,内侧距离前正中线1．0～1．4cm,外侧距离前正中线4．5～2．3cm。结论：额部有眶上动脉、滑车上动脉和颞浅动脉额支供血,吻合支丰富且吻合区域较恒定,故可制成多种类型的跨血管的反流式皮瓣。     

带颞浅血管颅骨瓣修复颌面部缺损的应用解剖

目的：为带颞浅血管蒂颅骨外板骨瓣转位修复颌面部缺损提供解剖学基础。方法：在30侧经动脉灌注乳胶的成人尸体标本和8头颈铸型标本（5例保留骨骼）上,对颞浅动脉的走行、分支及分布进行观测,并在标本上进行模拟术式设计。结果：颞浅动脉起自颈外动脉,于外耳门前方越过颧弓根部浅出至皮下,在皮下组织和颞浅筋膜之间向前上走行,至颧弓上方分为额、顶二终支,其分支营养颅顶部大至3/4区域的软组织、骨膜和颅骨外板,颞浅动脉主干及额支、顶支动脉外径均大于1mm,浅出部位至颞线处可游离长度为8cm以上。结论：设计以颞浅动脉为蒂颅骨外板骨瓣转位修复颌面部缺损具有可行性。     

上颌骨血管构筑及其临床意义

目的:研究上颌骨血供来源、主要血管走行与分布及各相关血管吻合情况,为上颌骨各型截骨术提供形态学基础。方法:6例成人头部标本,其中2例为新鲜头部标本,经两侧颈总动脉注入红色过氯乙烯乙酸乙酯填充剂,经腐蚀后制成头部血管铸型标本;4例为福尔马林浸泡标本,常规局部解剖,详细观察上颌骨内、外侧面血管走行、分布、吻合情况。结果:上颌骨主要由上牙槽动脉供血,上颌骨粘骨膜主要由上牙槽后动脉颊支、眶下动脉分支、腭降动脉分支供血;上颌骨内供血动脉与上颌骨粘骨膜存在广泛交通支,使上颌骨形成内外供血动脉相交通的立体血管网。结论:上颌骨血供的多源性,为截骨段成活、截骨段移动等提供了形态学依据,为其各型截骨术的设计、临床操作提供了解剖基础。     

跨血管区反流耳颞部皮瓣应用解剖学

目的:明确耳颞部颞浅动脉系统与额部及眼眶区周围血管系统之间的交通吻合情况,为临床跨血管区反流耳颞部岛状皮瓣的应用提供解剖学基础.方法:15具福尔马林保存的成人尸体头面部进行肉眼解剖;5具新鲜成人头部标本制作血管铸型,观察颞浅动脉额支与眶上及滑车上动脉的相互交通吻合状况以及颞浅动脉分支与眼轮匝肌营养血管之间的吻合情况.结果:眶上及滑车上动脉和颞浅动脉额支走行基本恒定,且三者存在众多吻合,吻合支集中区域为上界距眶上缘(4.9±0.4)cm,下界为眶上缘水平,上界内侧距离前正中线(1.0±0.2)cm,外侧距离前正中线(4.5±0.4)cm;下界内侧距离前正中线(1.4±0.2)cm,外侧(2.3±0.5)cm;颞浅动脉分支—颧眶动脉以3种分支类型与面动脉的终末支—内眦动脉在眼轮匝肌内形成稳定的交通吻合.结论:颞浅动脉额支与滑车上动脉存在吻合支集中区域;眶上动脉与颞浅动脉额支在眉外侧存在位置恒定吻合点.以眼轮匝肌为蒂的颞区皮瓣实际上是以颧眶动脉远端和眼睑动脉弓为蒂的跨区反流轴型皮瓣.     

逆行颞顶筋膜瓣的解剖与临床应用

目的：探讨逆行颞顶筋膜瓣临床应用的可行性。方法：①在12侧成人头颅标本上,对颞顶筋膜的形态和血供进行巨微解剖观测。②分别以颞浅动脉的额支或顶支或额、顶支双蒂设计逆行颞顶筋膜瓣应用于临床修复头颅深度软组织缺损。结果：①颞顶筋膜主要由颞浅动脉供血,额支与顶支是颞浅动脉的终末分支,颞浅动脉经额支、顶支与耳后动脉、枕动脉、眶上动脉、滑车上动脉及对侧颞浅动脉有丰富吻合。颞浅静脉由静脉额支和静脉顶支汇合而成,动、静脉额支及可动、静脉顶支基本伴行。②临床应用6例逆行颞顶筋膜瓣均获成功。结论：逆行颞顶筋膜瓣供血可靠,具有采取方便、供区隐蔽等优点,适用于额、顶、枕等处深度软组织缺损的修复。     

颈浅动脉游离皮瓣的应用解剖

目的：为开发颈浅动脉游离皮瓣的应用提供解剖学基础。方法：解剖观测３０ 侧成人尸体标本颈横动脉及其浅支的起源、走行、分支、分布及其吻合情况,对其肌皮穿支进行体表定位。结果：颈浅动脉为颈横动脉的主要分支。颈横动脉起点至斜方肌前缘５ ．５ ±０ ．８ ｃｍ 。颈浅动脉起点外径２ ．１ ±０ ．３ｍ ｍ ,有２ 条伴行静脉。其肌皮穿支恒定的有２ 支,血管蒂长７ ～８ ｃｍ 左右。结论：颈浅动脉有恒定的肌皮穿支,体表定位明确,血管蒂较长,管径较粗,吻合丰富,有２ 条伴行静脉,可以形成颈浅动脉游离皮瓣。     

吻合足底内侧动脉浅支足底内侧皮瓣移植修复手部缺损的应用解剖

目的为以足底内侧动脉浅支及其皮支为蒂游离足底内侧皮瓣修复手部缺损提供解剖学基础。方法在20侧成人下肢标本、6只灌注红色乳胶成人新鲜足标本及10侧下肢动脉铸型标本上解剖观测了足底内侧动脉浅支足底内侧皮支起始部位、走行、长度、外径、分支分布及吻合。结果足底内侧动脉浅支足底内侧皮支于舟骨粗隆后(1.5±0.4)cm下方发出,向前下斜行至足底内侧皮肤;该皮支长(2.8±0.2)cm,外径(0.8±0.2)mm。结论①足底内侧皮瓣可以是足底内侧动脉浅支足底内侧皮支或足底内侧动脉深支足底皮穿支为供血。②足底内侧皮瓣游离移植适用于手掌及手指腹侧创面修复的特殊需要。     

除皱术中以颞浅动脉额支定位面神经颞支的解剖学基础

目的探讨以颞浅动脉额支定位面神经颞支解剖学依据.方法选用防腐固定1 0例(20侧)新鲜标本5例(10侧),解剖观察颞浅动脉额支的走行分布及其与颞支的毗邻关系.结果①56.7%的颞支及其终末分支均走行在颞浅动脉额支下方的颞浅筋膜深面.②43.3%的颞支1～2终末分支可在眶上缘水平以上与颞浅动脉额支平行或交叉走行在其深面,终止于额结节下方.③颞支在颧弓上缘与颞浅动脉起始部的距离为(0.7±0.3)cm,走行过程中逐级发出分支分布于眼轮匝肌外侧部,最后呈网状分布于额结节下方的眼轮匝肌与额肌交汇处,支配眼轮匝肌、额肌、皱眉肌.结论以颞浅动脉额支、颧弓和经过额结节的矢状线所围成的三角形可简便直观地定位颞支的分布,在除皱术中具有实际的应用意义.     

小儿面神经血供的应用解剖学研究

目的探讨小儿面神经的动脉来源及分布。方法10具小儿尸体头颈部标本经双侧颈总动脉插管,加压注入红色乳胶,观察面神经的动脉来源及分布。结果面神经颅外段营养动脉来源于茎乳动脉、颞浅动脉面神经支、面横动脉、颈外动脉上面神经支、颈外动脉下面神经支、面动脉后面神经支和面动脉前面神经支。面神经颅内段营养动脉来源于茎乳动脉、脑膜中动脉的岩支、迷路动脉。结论为面神经血供来源及分布提供形态学基础,避免手术时损伤。     

面动脉穿支蒂颊黏膜瓣重建泪道的解剖学基础

目的为面动脉穿支蒂颊黏膜瓣重建泪道提供解剖基础。方法在10个20侧动脉内灌注红色乳胶的成人头标本上解剖观测:①面动脉穿支的起源、分支与分布;②颊动脉的起源、分支与分布;③面动脉与颊动脉的吻合。另在1侧新鲜标本上进行摹拟手术设计。结果颊黏膜的血供为多源性,主要由面动脉、颊动脉和上牙槽后动脉发出的穿支供养。①面动脉自颈外动脉发出,行至咬肌前缘越过下颌骨底达面部后,再斜向内上至内眦处与鼻背动脉吻合,沿途除发出分支营养颈、面部相应区域外,在口角外侧(1.10±0.31)cm处分出1~3支颊支,支配颊肌与颊黏膜前中部,并与颊动脉颊支、上牙槽后动脉颊支形成吻合;②颊动脉发自上颌动脉的翼肌段,行于颞肌下部深面前下方向,沿途发支分布于颊黏膜后中部,并与面动脉穿支相互吻合。当上颌动脉分出颊支细短时,则由粗大的上牙槽后动脉颊支(占5%)代偿。结论颊黏膜瓣血供丰富,可形成以面动脉穿支为蒂颊黏膜瓣转位重建泪道。     

婴幼儿腮腺血管瘤摘除术相关应用解剖及临床应用

目的：为婴幼儿腮腺血管瘤摘除术提供解剖学基础。方法：采用血管乳胶灌注、显微解剖的方法对婴幼儿腮腺血供来源及其与面神经的关系进行解剖学观察。结果：颈外动脉直接分支及耳后动脉、颞浅动脉、面横动脉等的分支旧腮腺主要的供血动脉;婴幼儿面神经分支类型与成人无明显差异,主干位置恒定,易寻找,各分支纤细。结论：婴幼儿腮腺血管瘤手术时,应先行颈外动脉中段结扎,然后寻找面神经主干,沿主干分离各分支,这样可降低手术难     

Cerebral Angiographic Findings of Cosmetic Facial Filler-related Ophthalmic and Retinal Artery Occlusion

Cosmetic facial filler-related ophthalmic artery occlusion is rare but is a devastating complication, while the exact pathophysiology is still elusive. Cerebral angiography provides more detailed information on blood flow of ophthalmic artery as well as surrounding orbital area which cannot be covered by fundus fluorescein angiography. This study aimed to evaluate cerebral angiographic features of cosmetic facial filler-related ophthalmic artery occlusion patients. We retrospectively reviewed cerebral angiography of 7 patients (4 hyaluronic acid [HA] and 3 autologous fat-injected cases) showing ophthalmic artery and its branches occlusion after cosmetic facial filler injections, and underwent intra-arterial thrombolysis. On selective ophthalmic artery angiograms, all fat-injected patients showed a large filling defect on the proximal ophthalmic artery, whereas the HA-injected patients showed occlusion of the distal branches of the ophthalmic artery. Three HA-injected patients revealed diminished distal runoff of the internal maxillary and facial arteries, which clinically corresponded with skin necrosis. However, all fat-injected patients and one HA-injected patient who were immediately treated with subcutaneous hyaluronidase injection showed preserved distal runoff of the internal maxillary and facial arteries and mild skin problems. The size difference between injected materials seems to be associated with different angiographic findings. Autologous fat is more prone to obstruct proximal part of ophthalmic artery, whereas HA obstructs distal branches. In addition, hydrophilic and volume-expansion property of HA might exacerbate blood flow on injected area, which is also related to skin necrosis. Intra-arterial thrombolysis has a limited role in reconstituting blood flow or regaining vision in cosmetic facial filler-associated ophthalmic artery occlusions.     

Topographical anatomy of the transverse facial artery

The transverse facial artery (TFA) is found in the lateral face and supplies the parotid gland and duct, facial nerve, facial muscles, and skin. To better understand the cutaneous vascularization of the lateral face and to better characterize the topography and other anatomical features of the TFA, microsurgical dissection was performed in 44 cadavers. The number of TFAs present ranged from one to three, and a single TFA was most common (70.5%). The TFA originated from the superficial temporal artery at or above the level of crossing by the temporofacial trunk of the facial nerve in the parotid gland (57.6%). The TFA divided into superior and inferior trunks in the gland, and continued as emerging branch. The superior emerging branch emerged from the gland superior to the parotid duct and divided into many branches. It supplied the malar area, crossed the parotid duct, terminated as perforator, vasa nervorum, or artery to the parotid duct or muscle. The inferior trunk in 72.5% continued as emerging branch instead of terminating in the gland. TFAs were classified into four types; the most common type was Type A in which the superior and inferior emerging branches and the duct‐crossing branch were present. The mean number of perforators to the superficial cutaneous layer was 1.9. Most perforators extended from the superior emerging branches (77.9%). The most common perforating site was below the duct on the anterior third of the masseter muscle. In two cases, the TFA formed an anastomosis with the facial artery. Clin. Anat. 23:168–178, 2010. © 2009 Wiley‐Liss, Inc.     

颞浅动脉额支皮瓣的应用解剖学

目的：为带蒂颞浅动脉额支皮瓣转移修复眼部软组织缺损提供解剖学资料。方法：对头面部乳胶灌注的标本进行解剖，并对颞浅动脉的走行、分支、分布进行观测。结果：颞浅动脉起自颈外动脉，穿腮腺实质上行，在颧弓上方分为额、顶两终末支。额支又于外毗上方分为额顶支和额眶支。额支、额顶支、额眶支血管外径均在1mm左右，可游离血管长度符合要求。结论：以颞浅动脉额支为蒂的皮瓣可用来转位修复眶周软组织缺损。     

对颈动脉鞘解剖的再认识及其意义

目的　通过对颈动脉鞘与颈筋膜关系的解剖观察,探讨对颈动脉鞘的正确认识。 方法 福尔马林处理的成人尸体标本20具（40侧）。解剖观察构成胸锁乳突肌筋膜后鞘的颈筋膜浅层与颈动脉鞘是否联结、联结的紧密程度;解剖观察颈动脉鞘与颈筋膜中层、椎前筋膜浅层、深层之间的关系、联结的质地与紧密程度。 结果 颈筋膜浅层与颈动脉鞘相联结,但较疏松,钝性分离可将二者分开;颈筋膜中层由舌骨下肌群各肌肉筋膜鞘汇合后向外侧续行汇入颈动脉鞘前部;椎前筋膜浅层向外侧分为浅、深两层,浅层包绕颈总动脉、颈内静脉和迷走神经,深层不参与构成颈动脉鞘。颈筋膜中层和椎前筋膜浅层与颈动脉鞘的联结质地韧厚,联结紧密。 结论 颈动脉鞘与颈筋膜各层存在密切的联系,颈筋膜中层和椎前筋膜浅层是构成颈动脉鞘的主体。     

Facial subdermal vascular network flap: anatomic study and clinical application

Despite the numerous flaps for facial reconstruction that have been described, the search for the ideal flap with good color matching and minimal donor-site morbidity continues. In the past 3 years we have repaired 13 facial defects with success using the lateral genicervical flap - a type of facial subdermal vascular network flap (SVNF) - with a pedicle located on the preauricular region. An anatomic study of the facial SVNF, including blood supply and vascular distribution of the face and anatomic characteristics of facial vessels, based on 14 cadaver dissections, was carried out. The blood supply of the facial skin basically originated from the branches of the facial, superficial temporal and infraorbital arteries. The lateral genicervical skin was supplied basically by the branches of the facial, superficial temporal and occipital arteries, but also by the terminal branches of the superior thyroid artery. The branches diverging from these arteries became superficial and formed a subcutaneous arterial network. The arterioles from the network went to the corium layer and formed a subdermal arterial network whose arterioles anastomosed with each other in a honeycomb-like structure. The vascular distribution presented certain directivity on different areas. The blood supply of the pedicle originated from the subdermal vascular network formed by the perforator branches of these arteries. The arterioles from the facial and superficial temporal arteries anastomosed in the lateral genicervical region. From the anatomic study, we think that the viability of the facial SVNF depends basically on the subdermal vascular network formed by the perforator branches of the pedicle, and that the anastomoses between the facial and superficial temporal arteries provide a solid anatomic basis to the lateral genicervical flap. The clinical data also indicated that this flap is a useful alternative for facial, especially superficial temporal, defects. But the directivity must be taken into account in its clinical application.     

The human anterior tympanic artery. A nutrient artery of the middle ear with highly variable origin

The variability of the origin of the anterior tympanic artery was investigated in 104 individuals of both sexes. A surprising laterality was found: thus, while the left anterior tympanic artery originated as a singular vessel from either the maxillary or the superficial temporal artery with almost equal frequencies (44.7 and 45.9%, respectively), the right anterior tympanic artery predominantly branched off from the maxillary artery (77.8% of cases). Besides the origin from either the maxillary artery or the superficial temporal artery, also anterior tympanic arteries branching off from the external carotid artery were found to occur (4% on the left and 1% on the right side). Although in the majority of individuals, a singular anterior tympanic artery occurred within the infratemporal fossa, duplications of the anterior tympanic artery were found to be present: in one case on the right and in 8 cases on their left side. In 1 female individual, a triplet of left anterior tympanic arteries was found to supply the tympanic cavity. Also in these cases, the anterior tympanic artery arose from either the external carotid, the superficial temporal or the maxillary artery. In singular cases, even several other branches of the maxillary artery, viz. the deep auricular, middle, and accessory meningeal, as well as the posterior deep temporal, inferior alveolar and masseteric arteries were found to form common trunks with the anterior tympanic artery.