以颞浅血管为蒂的耳后乳突区皮瓣的应用解剖

在17侧防腐尸体上于颞浅动脉内推注染料,观察其对耳后乳突区皮瓣的血供。耳后乳突区皮肤的血供除来自耳后动脉外.还有颞浅动脉顶支发出的耳后支直接分布。顶支与耳后动脉之间有一血管吻合区域.临床6例活体观察证实了上述结果。应用以颞浅血管为蒂的耳后乳突区皮瓣,进行颜面器官的修复再造14例,获得良好效果。     

Extrinsic and intrinsic blood supply to the optic chiasm

Although there have been many studies of the arterial cerebral blood supply, only seven have described the optic chiasm (OC) blood supply and their results are contradictory. The aim of this study was to analyze the extrinsic and intrinsic OC blood supply on cadaveric specimens using dissections and microcomputer tomography (Micro‐CT). Thirteen human specimens were dissected and the internal or common carotid arteries were injected with red latex, China Ink with gelatin or barium sulfate. Three Micro‐CTs were obtained to reveal the intrinsic blood supply to the OC. The superior hypophyseal arteries (SupHypA) (13/13) and posterior communicating artery (PCoA) (12/13) supplied the pial network on the inferior side of the OC. The first segment of the anterior cerebral artery (ACA) (10/10), SupHypA (7/10), the anterior communicating artery (ACoA) (9/10), and PComA (1/10) supplied the pial network of its superior side. The intrinsic OC blood supply was divided into three networks (two lateral and one central). Capillaries entering the OC originated principally from the inferior pial network. The lateral network capillaries had the same orientation as the visual lateral pathways, but the central network was not correlated with the nasal fibers crossing into the OC. There was no anastomosis in the pial or intrinsic networks. Only SupHypA, PCoA, ACoA, and ACA were involved in the OC blood supply. Because there was no extrinsic or intrinsic anastomosis, all arteries should be preserved. Tumor compression of the inferior intrinsic arterial network could contribute to visual defects. Clin. Anat. 31:432–440, 2018. © 2017 Wiley Periodicals, Inc.     

耳后皮瓣血管的显微外科解剖学基础

目的:研究颞浅动脉和耳后动脉之间的血管联系,以确定带不同血管蒂的耳后皮瓣的血供范围和皮瓣设计。方法:8具新鲜成人尸体经双侧颈总动脉灌注氧化铅-明胶混合液。掀起全层头皮和面部皮肤,将其展平摄X光片。结果:血管造影显示颞浅动脉和耳后动脉之间存在两种类型的血管吻合:一种是耳后区直接吻合,即在耳廓后面上方皮肤内可见颞浅动脉和耳后动脉发出的耳支之间存在直接吻合;另一种是头皮区网状吻合,即在耳上方头皮内可见来自颞浅动脉顶支和耳后动脉终末支之间的网状吻合。结论:本文结果有助于外科医生了解颞浅动脉和耳后动脉之间的血管联系,对耳后皮瓣的设计和改进提供可靠的解剖学基础。     

胰头的动脉分布及其临床意义

目的：为胰头和十二指肠的分部切除提供应用解剖学依据.方法：选取9例动脉灌注乳胶的胰头标本和3例胰头铸型标本对胰头的动脉分布进行解剖学观测.结果：胰头的动脉主要来源于前后动脉弓;其内部动脉可分为浅深两层和钩突部动脉.浅层动脉4条,以第1支最粗大;深层动脉主要由后动脉弓最上的3条分支营养,其中第3分支是最主要营养支;乳头动脉为后上动脉第3分支上发出的二级分支;钩突部的内部血供主要来自胰下动脉的下降支;在胰头内部浅深层及钩突部营养动脉间有着丰富的交通支,形成广泛的吻合.结论：胰十二指肠后上动脉在胰头与十二指肠血供中占据十分重要的位置,在术中保护好该动脉是手术成功与否的重要一环.     

全耳再造的解剖学基础研究

目的 :为更好地开展全耳再造术提供解剖学基础。方法 :①观察头面部血管铸型标本 10例 18侧 ,②用逐层解剖的方法观察 10例经 10 %福尔马林固定的成人头部标本和 5例新鲜成人头部标本。结果 :①耳廓及乳突区是由耳后动脉和颞浅动脉相互吻合形成的血管网供血。②耳廓的组织层次简单 ,可以认为耳廓是由皮肤包裹软骨形成的一个附属结构。结论 :①皮肤扩张法耳再造术在皮下层进行皮肤扩张最为理想 ,可形成薄的真皮下血管网皮瓣。②颞顶筋膜瓣可作为耳后皮瓣的补充 ,用于耳廓再造。③残耳可分为三部分进行充分利用。     

The arterial blood supply of the pancreas: a review. V. The dorsal pancreatic artery

Summary The present article is the fifth part of a comprehensive review on the arterial blood supply of the pancreas and deals with the dorsal pancreatic artery. The aim of this review is to summarise the anatomic studies, starting from Haller's reports, and to supply, as far as possible with original material, angiographic evidence for the classic anatomic notions. For this purpose, the overall research was carried out by studying 1015 selective angiographies (celiac trunk and its branches, superior mesenteric artery) taken from the angiographic archives of the Institutes of Radiology of Siena, Rome (Catholic University), and Perugia. Angiographically, the authors could demonstrate the dorsal pancreatic artery, present in most instances, as arising from the splenic artery, common hepatic artery, superior mesenteric artery or celiac trunk and accessory right hepatic artery as coming from the superior mesenteric artery. Variations in the course and length of the dorsal pancreatic artery were demonstrated as well as some collateral branches. The authors underline the discordant opinions still existing regarding the incidence of the different ways the dorsal pancreatic artery arises, and discuss its uncertain embryologic development and surgical relevance.

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Vascularisation artérielle du pancréas

Résumé Cet article sur l'artère pancréatique dorsale représente le cinquième d'une étude d'ensemble sur la vascularisation artérielle du pancréas. Le but de cette étude est de résumer les recherches scientifiques depuis les rapports de Hallers, et de fournir avec un support original si possible, des preuves angiographiques des notions anatomiques classiques. Pour atteindre cet objectif, l'ensemble de la recherche a été réalisée en sélectionnant et en étudiant 1 015 angiographies (tronc coeliaque et ses branches, artère mésentérique supérieure) puisées dans les archives angiographiques de l'Institut de Radiologie de Sienne, de l'Université Catholique de Rome et Perugia. Angiographiquement, les auteurs pourraient démontrer que l'artère pancréatique dorsale, présente dans la plupart des cas, comme issue de l'artère splénique, de l'artère hépatique commune, de l'artère mésentérique supérieure, du tronc coeliaque et accessoirement de l'artère hépatique droite issue de l'artère mésentérique supérieure. Des variations dans la position et la longueur de l'artère pancréatique dorsale sont démontrées, tout comme quelques branches collatérales. Les auteurs soulignent les opinions discordantes qui demeurent concernant l'incidence des différentes directions dans lesquelles l'artère pancréatique dorsale se dirige et discutent son développement embryologique incertain et son intérêt chirurgical.

     

Anatomy and blood supply of the subgaleal fascia flap

The subgaleal fascia (SGF) is a distinct layer in the temporal fossa situated between the superficial fascia and galea aponeurotica and the temporal fascia covering the superficial surface of the temporal muscle. The SGF is used most frequently for otologic reconstruction. Reviewing the literature, however, showed many contradictory findings about dissection of an independent SGF layer, its blood supply, and the possibility of harvesting it as part of a combined flap. Our study, carried out on ten fresh cadavers, presents a detailed view of the blood supply of the SGF to develop a safe method of harvesting an inferior-based SGF. Our systematic plane-by-plane approach, associated with a transparent grid applied on each dissection, allowed us to quantify the branches from each plane and to localize precisely their entering sites from a reference "zygomatic point." The SGF had no ascending axial vascular supply entering from its base; according to our results, therefore, the SGF could not be harvested alone as an inferior pedicled flap down to the zygomatic arch. It may be feasible, however, to harvest a SGF flap when a strip of the superficial fascia is associated with its middle third. Therefore, we suggest that an average height of 5.4 cm of superficial fascia should be included in an inferior-based pedicle of a SGF.     

The arterial supply of the temporalis muscle

Owing to the diverse applications of the temporalis muscle in reconstructive surgery, the study of its arterial supply is becoming an issue of great importance nowadays. The material of the present study consisted of 44 specimens, four obtained from two stillbirths and 40 dissected from 20 embalmed cadavers after injecting the external carotid artery with lead oxide solution. Direct branches from the second part of the maxillary artery and the middle temporal artery proved to be constantly furnishing the muscle from its superficial and deep surfaces. The muscular branch of the middle temporal artery supplied the middle and posterior thirds of the superficial surface and the posterior third of the medial surface of the muscle. The superficial temporal artery participated in supplying the muscle from its lateral surface, while the anterior and posterior deep temporal arteries lay deep to the anterior and the middle thirds of the muscle, respectively. The temporal branches of the middle meningeal artery anastomosed with the deep temporal arteries, thereby contributing to the supply of the temporalis muscle. An arterial pedicle arising from the third part of the maxillary artery constituted an additional supply in 9.1% of the specimens, providing an additional arterial pedicle for temporalis-muscle-flap elevation.     

胫神经束组及其血供的解剖学研究

目的　观察小腿段胫神经束组及其血供,为小腿段胫神经损伤修复或游离移植提供解剖学依据。 方法　①成人小腿标本26侧,分离胫神经主干及主要肌支,观察和测定各支横径、长度、起始位置、神经束无损伤分离长度。② 4侧新鲜成人小腿标本分别行动脉乳胶及墨汁灌注并制作透明标本,观察胫神经营养动脉。③ 4侧新鲜成人小腿标本上,死亡4 h内取下胫神经及分支并行胆碱酯酶染色,观察胫神经感觉束、运动束分布。 结果　胫神经主要肌支均在小腿8/8~6/8段分出,5/8~1/8段无重要肌支发出;胫神经干中内侧束组、外侧束组自然分束的距离长,平均为(361.4±7.1) mm;胫神经营养动脉丰富,胫后动脉与胫神经全程伴行,为其主要营养动脉;7/8~5/8段主要来自腓动脉,5/8~1/8段主要来自胫后动脉;胫神经内、外侧束组有相对独立的、完善的血供系统。 结论　胫神经上述解剖学特点为小腿部胫神经损伤的修复提供一定解剖学依据。小腿5/8~1/8段胫神经束组具有独立和完善血供系统,内外侧束组无损伤分离长度长,具备了带血供游离移植的供体神经解剖学特点。     

Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee

Summary The authors have studied, on the basis of purely radiologic data, the modifications of the popliteal arterial axis during flexion of the knee. They note the appearance in the sagittal plane of very marked flexures of the upper part of the artery, while the lower part describes a harmonious curve. These modifications take place between two fixed points: a cranial fixed point, represented by the origin of the descending artery of the knee, and a caudal fixed point represented by the origin of the anterior tibial artery. The pathologic importance of these modifications of the course of the artery should not be underestimated when obtaining revascularization by means of an arterial prosthesis.

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Modifications dynamiques de l'axe artériel poplité dans le plan sagittal au cours de la flexion du genou

Résumé Les auteurs étudient, à partir de données exclusivement radiologiques, les modifications de l'axe artériel poplité au cours de la flexion du genou. Ils constatent l'apparition de flexuosités très marquées au niveau de la poplitée haute, alors que la poplitée basse décrit une courbe harmonieuse, dans le plan sagittal. Ces modifications se font entre deux points fixes: un point fixe crânial, représenté par la naissance de l'artère descendante du genou, et un point fixe caudal représenté par la naissance de l'artère tibiale antérieure. L'importance de ces modifications du trajet artériel ne doit pas être sous-estimée en pathologie lors des revascularisations artérielles prothétiques.

     

The arterial blood supply of the pancreas: a review

Summary The gross anatomy of the pancreatic blood supply has been subjected to numerous studies. The results of such studies, however, have never been summarized in detail, even in the most important textbooks. For this reason, a certain confusion was generated, especially regarding the interpretation of the nomenclature used to identify pancreatic arteries. This review summarizes more than two centuries of studies of the gross anatomy of the pancreatic blood supply, clarifies the arterial nomenclature, and underlines the aspects about which anatomists are not in agreement. Moreover, it supplies, as far as possible, documentary evidence for numerous observations previously reported only verbally. For this purpose, more than 200 references were directly consulted to provide the anatomical background of the topic, and more than 1000 angiograms were studied to support the review with original figures. The present paper, on the superior pancreaticoduodenal and anterior superior pancreaticoduodenal arteries, is the first of a series of articles dealing with the pancreatic blood supply.

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Etude anatomo-radiologique de la vascularisation artérielle du pancréasI. Les artères pancréaticoduodénale supérieure et pancréaticoduodénale antérieure et supérieure

Résumé L'anatomie de la vascularisation du pancréas a fait l'objet de nombreux travaux. Les résultats de ces études n'ont jamais été récapitulés en détail, même dans les livres les plus importants. C'est pourquoi une certaine confusion est née, spécialement en ce qui concerne l'interprétation de la nomenclature utilisée pour indentifer les artères pancréatiques. Ce travail résume plus de deux siècles d'études d'anatomie générale de la vascularisation du pancréas, il clarifie la nomenclature des artères et souligne les points sur lesquels les anatomistes ne sont pas d'accord. En outre il fournit, autant que faire se peut, des documents concernant de nombreuses observations antérieures rapportées uniquement oralement. Dans ce but plus de 200 références ont été consultées directement pour fournir la documentation anatomique de ce sujet et plus de 1000 angiographies ont été étudiées pour illustrer ce travail avec des figures originales. Le présent article sur les artères pancréatico-duodénale supérieure et pancréatico-duodénale antéro-supérieure est le premier d'une série de travaux se rapportant à la vascularisation du pancréas.

     

The arterial blood supply of the human patella

Summary The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o'clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.

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La vascularisation artérielle de la patella humaine : son importance clinique dans la technique opératoire des transplantations vascularisées d'articulation du genou

Résumé La disposition des artères alimentant le réseau patellaire a été examinée sur 14 pièces anatomiques dans le but d'améliorer la technique de la transplantation de l'articulation du genou. Les pièces étaient fixées dans la solution de Jores et désarticulées à la hanche. Les membres inférieurs étaient injectés à la gélatine colorée au bleu de Berlin et les artères étaient disséquées sans grossissement optique. Cinq ou six artères alimentaient le réseau patellaire à 1, 3, 5, 7 et 11 heures et formaient un cercle artériel. Ces artères sont les mêmes artères principales qui vascularisent la partie distale du fémur et la partie proximale du tibia. D'un point de vue anatomique, ces artères fournissent la totalité de la vascularisation artérielle de l'articulation du genou à transplanter, patella incluse. A partir de ces résultats anatomiques, nous avons préparé et transplanté deux articulations de genou humaines comme allogreffes vascularisées incluant la patella, la capsule et le ligament patellaire. Plus de 6 mois après l'intervention, nous avons montré la vascularisation et la réhabitation de ces trois os transplantés, en particulier de la patella grâce à la scintigraphie au technetium 99. Nous avons comparé ces résultats avec les données de l'arthroscopie et l'analyse histologique des biopsies prélevées au niveau de la patella. Les examens postopératoires ont clairement montré la réhabitation des patellas transplantées grâce à cette nouvelle technique opératoire. Les résultats de cette étude montrent qu'il est techniquement faisable de transplanter une articulation du genou entière, qui reste cliniquement viable.

     

The arterial blood supply of the human patella

The architecture of the arteries supplying the patellar rete was examined in 14 anatomic specimens in order to develop an optimized operating technique for knee joint transplantation. The specimens were fixed in Jores Solution and exarticulated from the hip joint. The lower limbs were injected with Berliner-Blau-Gelatin, and the arteries were dissected macroscopically. Five to six main arteries entered the patellar rete at 1, 3, 5, 7 and 11 o’clock forming an arterial circle. These arteries were the same main arteries which supply the distal end of the femur and the proximal part of the tibia. From an anatomic perspective, they provide the complete arterial blood supply to a whole knee joint being transplanted including the patella. Based on these anatomic results, we transplanted two allogenic vascularized human knee joints preserving the patella, the capsule, and the patellar ligament. Up to six months after surgery we demonstrated the perfusion and viability of all three transplanted bones, particularly the patella, by 99mTc DPD scintigraphy. We compared these findings with knee joint arthroscopy and with histologic results from biopsies taken from the patella. The postoperative examinations clearly indicated the viability of the transplanted patella employing this new operating technique. The results of the entire study demonstrate that it is technically feasible to transplant a whole knee joint which remains clinically viable.     

副神经血供的解剖学研究及临床意义

目的　解剖观察副神经血供来源及血供形式,为临床带血管蒂副神经移植及带血管的肌肉神经复合皮瓣的应用提供形态学依据。 方法 15例（30侧）新鲜尸体动脉灌注乳胶和聚乙烯醇-氧化铋造影显微解剖与X线摄影,观测副神经滋养血管来源、分支及起始外径、血管起始处到副神经的垂直距离、动脉伴副神经走行的最远距离及副神经血供特点。 结果 副神经的血供呈节段性分布,有枕动脉、颈浅动脉、颈横动脉和肩胛背动脉,营养副神经的主干支血管起始处外径依次为（1.5±0.5）、（2.3±0.2）、（2.1±0.3）、（1.8±0.5）mm,各血管起始处至副神经的垂直距离依次为（1.6±0.6）、（4.6±0.4）、（4.8±0.7）、（1.0±0.3）cm,发出数支分支血管进入副神经主干及分支, 伴行副神经走行的距离依次为（4.1±0.7）、（7.3±0.6）、（8.6±0.6）、（8.5±0.5）cm。 结论 副神经血供为枕动脉、颈浅动脉、颈横动脉、肩胛背动脉以及各自的分支节段血管,为副神经神经移术时应重点加以保护。     

中指动脉解剖及在皮瓣设计中的意义

在放大５～１０倍的手术显微镜下解剖观察了３２侧带色乳胶灌注的新鲜成人中指动脉及其分支。中指掌侧固有动脉有４条较为恒定的桡、尺侧吻合支，分别位于近节指骨头部、中节指骨头部、末节指骨中部和甲根部。这些吻合支口径０．３～０．４ｍｍ，是设计中指逆行岛状皮瓣的血供基础，切取时需加以保留。中指掌侧固有动脉向掌侧发出７条皮支，向背侧发出４条皮支，这些细小皮支可作为局部皮瓣的供血动脉。其中向背侧发出的第一、第二两分支因位置恒定，走行距离长，皮肤质地良好等优点，是修复中指掌面和侧面皮肤缺损皮瓣设计的解剖学基础。     

上下唇血液供应及其临床意义

目的：研究上下唇的血液供应,为新的组织瓣设计提供解剖学基础。方法：对10具从面动脉灌注红色乳胶的成年新鲜尸体标本的口周区域进行解剖研究,在2具尸体标本的面静脉内注入兰色乳胶。在3.5倍的手术放大镜下解剖显著血管。结果：上唇动脉发生浅隔支与深隔支,向上走行进入鼻中隔前下部参与克氏动脉丛的组成。观察到2种新的下唇动脉的分布情况。下唇动脉沿途发出唇颏支,与进入颏部的其它血管分支相互吻合。结论：上下唇血供丰富,可设计含浅、深隔支的上唇岛状组织瓣、含鼻隔支的岛状鼻中隔软骨粘膜瓣及含颏唇支的颏唇瓣;了解下唇动脉的解剖变异,对成功地施行一期下唇动脉岛状瓣手术是很重要的。     

The posterior part of the human cerebral arterial circle (CAC): arterial caliber from gestational weeks 13 to 24

Numerous studies have reported that all components of the cerebral arterial circle in the 4-month-old human fetus are more slender than adult vessels, and of equal caliber. After that period, a degree of caliber differentiation is present, especially at the level of the posterior communicating arteries. The aim of this study was to determine arterial diameters in the posterior part of the fetal cerebral arterial circle from the 4th month (IV) to the 6th (VI). One hundred and seventy-two fetal cerebral arterial circles were examined by means of a surgical microscope. It was determined that average diameters of the left (right) pre-communicating parts of the posterior cerebral artery ranged from 0.30 +/- 0.03 (0.29 +/- 0.02) mm in month IV, to 0.36 +/- 0.04 (0.36 +/- 0.03) mm during month V and up to 0.55 +/- 0.22 (0.50 +/- 0.18) mm in month VI. The average diameters of the left (right) posterior communicating artery ranged from 0.24 +/- 0.02 mm (0.25 +/- 0.02) in month IV, to 0.30 +/- 0.03 mm (0.29 +/- 0.05) during month V and up to 0.38 +/- 0.08 (0.44 +/- 0.10) in month VI. Gender differences between posterior cerebral artery and posterior communicating artery diameters were not significant. Average posterior cerebral artery diameters were significantly larger than posterior communicating artery diameters in months IV and V, but not in month VI. It was established that caliber differentiation in the posterior part of the cerebral arterial circle began from gestational month IV, and that gender differences in arterial diameters were not significant until month VI of gestation.