带阴毛穿支皮瓣的应用解剖

目的　探讨阴阜区穿支血管的解剖学特征,为修复头面部带毛区皮肤软组织缺损提供解剖学基础。 方法　选用体积分数10%甲醛常规防腐固定的成人尸体标本15具（30例,男18例、女12例）,采用乳胶灌注、显微解剖、摹拟手术等方法,重点观测：①阴阜区穿支血管的起始、走行、分支与分布;②阴阜区穿支间的吻合情况。 结果　阴阜区皮肤血供主要由阴部外浅动脉供养,该动脉自股动脉发出后行向内上,在大隐静脉末段内、外侧分出上、下两支。上支向内上跨过腹股沟韧带进入阴阜部,并在前正中线附近与对侧同名动脉相吻合,走行过程中发皮支供养阴阜部阴毛覆盖区大部皮肤。下支近水平行向内侧进入耻骨前区,沿途分支营养股内侧部上份、耻骨前区及阴囊（唇）。上、下支起始外径分别为（1.2±0.2）mm和（1.1±0.3）mm。 结论　阴阜区皮肤血供丰富,可以阴部外浅动脉穿支为蒂设计带阴毛阴阜区皮瓣修复头面部带毛区皮肤软组织缺损术式。

Clinical anatomy of the pubic hair-bearing perforator flap

Objective To investigate the anatomical characteristics of the perforating vessels in the pubic area,providing anatomical basis for reconstruction of soft tissue defects in the maxillofacial hairy region.Methods 30 sides of adult cadaveric specimens(18 sides of male,12 sides of female)were fixed by 10%formaldehyde conventionally,followed by managements of red latex artery perfusion,microscopic anatomy,and mimic operation.The following contents were observed:①The origin,course,branch,and distribution of the perforating vessels in the pubic area;②The anastomosis of the perforators in bilateral pubic area.Results The skin blood supply of the pubic region was mainly provided by the superficial external pubic artery,which originated from the femoral artery,and then bifurcated into the superior branch and the inferior branch when arriving at the terminal segment of the great saphenous vein.The superior branch crossed over the inguinal ligament and entered into the pubic area,and finally anastomosed with the contralateral homonymous artery near the anterior midline.Along the way,it sent out cutaneous branches to nourish most of the hairy skin in the pubic area.The inferior branch entered into the pubic proparea horizontally and sent out branches to nourish the medial-superior thigh,the pubic proparea and the scrotum(labium).The average starting outer diameter of the superior branch and the inferior branch were(1.2±0.2)mm and(1.1±0.3)mm,respectively.Conclusions The pubic area was abundant and reliable in blood supply,which allowed to design a hair-bearing perforator flap based on the superficial external pubic artery for reconstruction of skin and soft tissue defects in the maxillofacial hairy region.