皮肤穿支血管的解剖学研究

目的：对全身皮肤血管区域进行定性和定量分析，确定全身皮肤穿支血管的位置、数量、口径、穿支蒂的长度、类型、来源血管以及穿支所供应皮肤的面积，为穿支皮瓣提供血管解剖基础。方法：选用10具新鲜尸体，采用改良氧化铅一明胶灌注技术进行动脉灌注。将每个口径大于0．5mm的穿支血管进行解剖并记录。拍摄X线片以显示皮肤内血管的形态和分布。定量数据分析包括全身各部位的穿支血管的数量、口径、类型及其供应区域的面积。结果：发现全身128支起源血管发出440支穿支供应皮肤。其中肌皮穿支与肌间隔穿支之比为3：2。穿支平均直径为0．7mm。穿支血管的分布规律如下：①躯干皮肤的血供主要来自肌皮穿支，这些穿支在皮肤内的走行距离和分布范围大于肢体皮肤的穿支。②肢体皮肤的血供主要来自肌间隙穿支血管，主要分布在深筋膜表面，皮神经和浅静脉周围穿支之间形成链式血管吻合。③单位面积的穿支数量与皮肤的移动程度成反比，穿支的口径大小和穿支在皮肤内走行距离与皮肤移动度成正比，与穿支的供应面积成正比。结论：本研究提供详细的皮肤穿支血管解剖数据，为临床设计应用穿支皮瓣提供解剖学依据。

Anatomical study of perforator vessel to the human skin

Objectives: This study focuses on the anatomical potential of perforator flaps by describing the vascular architecture of the integument and quantifying the distribution of the principal source arteries to the skin. Methods: Ten fresh human cadavers were injected using a modified lead oxide and gelatin injection technique. The entire integument was removed and radiographs were taken to assess the pattern of cutaneous vascular distribution. Each cutaneous vessel greater than 0.5 mm in diameter was dissected recorded in dissection notes and photographed. Data analysis included area calculations for the area of skin supplied by each perforator, and the number, diameter, and type of arterial perforators in each anatomical region. Results: In total there were an average of 440 significant perforators supplying the integument from 128 source arteries. Musculocutaneous perforators out numbered septocutaneous perforators in a ratio of 3:2. The vascular territory of each source vessel was analyzed and assessments made regarding each region. Conclusions: Our results show that there are many novel donor sites in the body suitable for perforator flap design. This study provides an anatomic data for harvesting potential perforator flap as a donor site.