颞浅动脉分支与静脉伴行解剖基础及临床应用

目的 了解颞浅动脉分支走行及静脉伴行规律,为临床皮瓣手术设计提供解剖学依据. 方法 解剖10具成人尸体标本头面部(共19侧)并拍照,利用Digimizer图形分析软件建立以外耳孔为原点的坐标,测量分析颞浅动脉额支及顶支走行和伴行静脉.以此解剖结构为基础,用超声多普勒探查颞浅动脉及分支,低头憋气法或环扎法显示相应静脉,设计轴心线位于动静脉之间的转位皮(筋膜)瓣10侧,修复2008年2月-2009年12月笔者单位收治的面部损伤患者9例.数据行方差齐性检验. 结果 19侧标本中,额支伴行静脉缺如6侧,动静脉间最大间距(2.1±1.2)cm;顶支伴行静脉缺如3侧,动静脉间最大间距(1.4±0.7)cm.额支间血管距离大于顶支,且前者离散程度高于后者(F=0.0404,P=0.0475).皮(筋膜)瓣全部成活,无淤血、坏死. 结论 选用颞浅血管分支为轴心血管时,皮瓣设计应根据静脉伴行情况而定,避免术后因静脉回流障碍致皮瓣坏死.低头憋气法或环扎法可较好显现颞浅静脉及其分支,该法简单实用、安全可靠.

Anatomic basis of the accompanying pattern of the superficial temporal arterial branches and veins and its clinical application

Objective To study the course of branches of the superficial temporal artery (BSTA)and the accompanying pattern of their veins in order to provide anatomic basis for flap design. Methods Head and facial part of ten adult corpses(19 sides) were dissected and photographed. The coordinate system was set up with external auditory foramen as the point of origin, aided by the graph analysis software Digimizer. The course of the frontal branch and parietal branch of the superficial temporal artery (STA) ,and the accompanying pattern between the BSTA and the veins were measured and analyzed. The STA and its branches were located by Ultrasonic Doppler, and the corresponding branches of the superficial temporal vein (BSTV) were disclosed by bowing patient's head with breath holding or cerclaging the basement of the patient's skull. And then 10 sides of transposition (fascia) flaps with axis at the angular bisector between BSTA and BSTV were devised to repair wounds of 9 patients that hospitalized from February 2008 to December 2009. Data were processed with test of variance homogeneity. Results Frontal BSTV absence was found in 6 head sides, and the maximum distance between artery and vein was (2. 1 ± 1.2) cm. Parietal BSTV absence was found in 3 head sides, and the maximum distance was(1.4 ± 0. 7) cm. The distance between frontal BSTA and BSTV was larger than that between parietal BSTA and BSTV, and the dispersion degree of the former was higher than that of the latter(F =0. 0404, P =0. 0475). All the (fascia) flaps survived without congestion or necrosis. Conclusions When branch of the superficial temporal vessel was selected as the axial vessel of flap, the flap design shall depend on the accompanying pattern of BSTV to avoid the flap necrosis due to poor venous return after surgery. The superficial temporal vein and its branches can be well disclosed by bowing head or cerclaging skull. The approach is simple, useful, safe, and reliable.